Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research.

AIMS: To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. DESIGN: Semi-structured qualitative interviews. SETTING: Denver, CO, USA. PARTICIPANTS: Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. MEASUREMENTS: Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. FINDINGS: Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. CONCLUSIONS: Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading.

Traversing the triangulum: the intersection of tobacco, legalised marijuana and electronic vaporisers in Denver, Colorado.

OBJECTIVE: To explore the intersection of tobacco, legalised marijuana and electronic vaporiser use among young adults in the 'natural laboratory' of Colorado, the first state with legalised retail marijuana. METHODS: We conducted semistructured interviews with 32 young adults (18-26 years old) in Denver, Colorado, in 2015 to understand the beliefs and practices related to the use of tobacco, marijuana and vaporisers. RESULTS: We found ambiguity about whether the phrase 'to smoke' refers to the use of tobacco or marijuana products. Smoking marijuana blunts (emptied cigarillo or tobacco wrap filled with marijuana) was common, but few interpreted this as tobacco use. Marijuana vaporisers were used to circumvent public consumption laws (eg, while at work or when driving). Young adults considered secondhand tobacco smoke dangerous, but perceived secondhand marijuana smoke as benign. DISCUSSION: Using tobacco products as a delivery method for marijuana (eg, blunts) might be increasing and normalising tobacco use among young adults. Surveillance should explicitly ask about use of tobacco products for marijuana. Marijuana vaporisers, often indistinguishable from nicotine vaporisers, may be used to circumvent public consumption laws; communities concerned about use of marijuana in public spaces should include vaporisers (for nicotine or marijuana) in smoke-free regulations. Tobacco, marijuana and electronic vaporisers should be studied together, rather than separately. This approach is essential in informing research and policy as more US states and countries worldwide move to legalise marijuana.

One of several 'toys' for smoking: young adult experiences with electronic cigarettes in New York City.

OBJECTIVE: This qualitative research explores the use of electronic cigarettes and other similar 'vapor' delivery devices among young adults in New York City. METHODS: We employed 17 focus groups followed by 12 semistructured interviews to understand the beliefs, opinions and practices related to the use of electronic cigarettes among young adult smokers (N=87). RESULTS: Participants were mainly daily (52%) and non-daily (41%) smokers. While experimentation with electronic cigarette devices was frequently reported, participants related an overall lack of information about the devices and what they did know often reflected messages in e-cigarette marketing campaigns. Participants also used their own bodily sensations as a way to gauge potential risks and benefits of the products. Finally, young adults, steeped in a culture of personal technologies, perceived e-cigarettes as one more 'toy' among other technologies integrated into their everyday lives. DISCUSSION: E-cigarettes were also frequently used with other tobacco products, including conventional cigarettes. Our research indicates that public health campaigns may be needed to counter current industry marketing and inform the public that electronic cigarettes are currently unregulated, understudied and contain toxicants and carcinogens.