Teens may have a firm grasp on the dangers of smoking cigarettes, but they appear less clear about how using marijuana or electronic cigarettes might harm their health, new research suggests.
“The most striking finding from this study was how little information adolescents were getting regarding risks related to marijuana and e-cigarettes,” said lead author Maria Roditis, a researcher at the Center for Tobacco Control Research and Education at the University of California, San Francisco.
“The youth we talked with actually mentioned the fact that they would see commercials talking about risks related to cigarettes, but there was nothing about marijuana or e-cigarettes,” Roditis said.
The findings were published online June 23 in the Journal of Adolescent Health.
The researchers conducted six small-group discussions with 24 teens from a Northern California school known to have high rates of substance use.
Discussion guides asked the teens what positive and negative effects they knew were related to cigarettes, marijuana and e-cigarettes, where they learned about these products, and why someone might use one over another.
Then the researchers identified common themes that arose from all the discussions. Generally speaking, the teens saw no benefits to smoking tobacco except perhaps helping someone relax, but they listed several harms, such as yellowing teeth, bad breath and cancer.
However, the teens had no difficulty listing benefits of using marijuana, such as getting high, relieving stress or pain, and relaxing. The main downsides the students listed about marijuana were getting in trouble because it is illegal and getting into dangerous situations while high. They were uncertain about health risks.
Similarly, the teens expressed confusion about whether e-cigarettes could be harmful or not. Some were uncertain whether they contained nicotine, and others suggested that using them looked “classy.”
“The fact that they are seeing messaging about risks related to cigarettes means that they may wrongly infer that cigarettes carry harm but that these other products that are not being discussed do not confer risks,” said senior study author Bonnie Halpern-Felsher, a faculty member with the Center for Tobacco Control Research and Education at the University of California, San Francisco.
The teens’ comments did not surprise Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.
“The impact of these products on lung health is not as well known, or what is known is not as widely publicized,” Folan said about e-cigarettes and marijuana. “Perhaps the legalization in many states has contributed to the perception that smoking marijuana is safer than conventional cigarettes.”
And, Folan added, “The knowledge gap about e-cigarettes is currently being filled in large part by the e-cigarette industry advertising rather than scientific information.”
She pointed out that regular marijuana use can double a person’s risk of experiencing psychotic symptoms, lead to getting less education, increase a person’s risk of chronic bronchitis and increase the risk of car wrecks while high.
“There is much variability in e-cigarettes, and more data are needed to demonstrate whether or not they are safe and/or effective in helping people quit smoking,” Folan said. “One of the concerns surrounding e-cigarettes is the possibility of re-normalizing smoking in society.”
Authors Roditis and Halpern-Felsher pointed out that the nicotine in e-cigarettes may negatively affect teens’ cardiovascular health and developing brains.
“There is concern that the flavorants in e-cigarettes that make them so attractive to youth are harmful, especially to the lungs and respiratory system,” Roditis said. “There is also concern that adolescents may use e-cigarettes as a bridge to start smoking conventional cigarettes.”
One way to address these gaps in knowledge is formal curriculum in schools about the risks of marijuana and e-cigarettes, said Dr. Edward Goldenberg, medical director of cardiovascular prevention at Christiana Care Health System in Wilmington, Del.
“Right now, there’s no Surgeon General’s warning on an e-cigarette that it can be detrimental to your health,” Goldenberg pointed out. “With the legalization of marijuana, it will likely become a growing public health concern, including work-site accidents, and there needs to be regulation of advertising e-cigarettes to children, as there is for regular cigarettes.”
Another problem is that public health officials simply are not creating messages about these products, said Halpern-Felsher.
“There needs to be messaging and interventions that address marijuana and e-cigarettes,” Halpern-Felsher said. “States need to ensure that they are creating policies, regulations and health initiatives that address teens’ perceptions and aim to reduce youth use and access.”
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