Perceived Harm, Addictiveness, and Social Acceptability of Tobacco Products and Marijuana Among Young Adults: Marijuana, Hookah, and Electronic Cigarettes Win

Abstract

Background: There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. Objectives: This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. Methods: In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products. Results: Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.

Keywords :

• tobacco use
• marijuana use
• social norms
• youth
• health risk
• addiction

THE AUTHORS

Carla J. Berg, PhD, is an assistant professor in the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health. Her PhD is in clinical health psychology, and her research interests are tobacco control, young adult health promotion, marijuana use, health disparities, cancer prevention and survivorship, health communication, and the use of marketing strategies to influence health behaviors.

Erin Stratton, MPH, is a graduate of the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health and a project coordinator working with Dr. Berg.

Gillian L. Schauer, MPH, is a PhD student in the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health and an ORISE Fellow at the Centers for Disease Control and Prevention in the Office on Smoking and Health. Her research interests include tobacco cessation, chronic disease prevention, multiple health risk behaviors, health systems change, and healthcare provider education.

Michael Lewis, PhD, is an associate professor in the Department of Marketing, Emory University Goizueta Business School. His research focuses on issues such as consumer response to loyalty programs, methods for customer valuation, and dynamic pricing.

Yanwen Wang, PhD, is an assistant professor in the Department of Marketing, Leeds School of Business, University of Colorado Boulder. Her research interests are the interaction between counter-marketing and public health.

Michael Windle, PhD, is a professor in the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health. His PhD is in developmental psychology, and his research interests include addiction, drug abuse prevention, child and adolescent health, mental health, and statistical modeling.

Michelle Kegler, DrPH, is a professor in the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health. Her research interests include chronic disease prevention, particularly tobacco control and obesity prevention, evaluation, and community-based participatory research.

GLOSSARY

• Cigarettes: Flavored, hand-rolled, and traditional cigarettes.

• Cigar products: Clove cigars, large cigars, little cigars, and cigarillos.

• Combustible tobacco: Cigarettes and cigar products.

• Current tobacco use: Any use in the past 30 days of tobacco or of each of the tobacco products included.

• Electronic cigarettes: Also known as a personal vaporizer (PV) or electronic nicotine delivery system (ENDS); a battery-powered vaporizer that generally uses a heating element known as an atomizer that vaporizes a liquid solution known as e-liquid.

• Hookah: A single or multi-stemmed instrument for vaporizing and smoking flavored tobacco called shisha in which the vapor or smoke is passed through a water basin—often glass-based—before inhalation.

• Smokeless tobacco: Chew, snus, dissolvable tobacco products.