Comparative Harm Perceptions of Vaping Nicotine Relative to Vaping or Smoking Cannabis and Their Associations With Adolescent Use Status

Objectives: Comparative harm perceptions of nicotine and cannabis may influence use. We explored adolescents’ comparative harm perceptions for vaping nicotine, vaping cannabis, and smoking cannabis, as well as associations with current use and susceptibility to future use. Methods: From April through May 2024, 4760 Connecticut high school students reported comparative perceptions of health harms from vaping nicotine, vaping cannabis, and smoking cannabis. Electronic nicotine delivery systems (ENDS) and cannabis use status were categorized by past-30-day use into 4 groups: no current use (86.9%), ENDS use only (3.4%), cannabis use only (3.5%), and dual use (6.2%). Among never users, susceptibility to ENDS or cannabis use was assessed (yes/no). Logistic regression assessed associations between harm perceptions and current use status and susceptibility. Results: Overall, adolescents perceived vaping nicotine as equally harmful (48.8%) as vaping cannabis but more harmful (45.3%) than smoking cannabis. Those perceiving vaping nicotine as less harmful than vaping cannabis (adjusted odds ratio [AOR] = 1.80; P = .03) or smoking cannabis (AOR = 2.50; P < .001) were more likely to report current ENDS use than no current use. Those perceiving vaping nicotine as more harmful than vaping or smoking cannabis were more likely to report current cannabis use or dual use and greater susceptibility to cannabis use (all P < .05). Conclusions: Adolescents commonly perceived vaping nicotine as equally or more harmful than cannabis use. Lower harm perceptions were associated with current ENDS/cannabis use and susceptibility to future cannabis use. Prevention strategies should enhance accurate risk perceptions of nicotine and cannabis to discourage uptake or product switching based on comparative harm beliefs.