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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.