Harm Perceptions of Smoking Versus Vaping Cannabis and Correlates: National Surveys of Youth and You

Nottage MK, Brose L, Robson D, Hackworth E, Reid JL, Hammond D, East K.
Harm Perceptions of Smoking Versus Vaping Cannabis and Correlates: National Surveys of Youth and Young Adults in England, Canada, and the United States
Addict Behav. 2026 Jun 25;182:108785. doi: 10.1016/j.addbeh.2026.108785. Epub ahead of print. PMID: 42361682.

Purpose: Cannabis products and routes of administration (e.g., smoking, vaping) vary. Harm perceptions are associated with use, yet little research examines these across routes of administration. We compared harm perceptions of cannabis smoking versus cannabis vaping and correlates among young people across England, Canada, and the US.

Methods: Youth (ages 16-19; n = 37,761) and young adults (20-29; n = 8,762) completed the ITC Youth & Young Adult Tobacco and Vaping Survey (2022-2024). Relative perceived harms of daily cannabis smoking versus daily cannabis vaping were assessed; adjusted regressions examined differences by country, mental health, nicotine smoking/vaping, and cannabis use.

Results: Overall, 10.4% of youth and 11.8% of young adults perceived smoking cannabis as more harmful than vaping cannabis. Odds of perceiving smoking cannabis as more harmful than vaping cannabis were higher in England versus the US (youth: OR = 1.89, 95%CI:1.69-2.13, p < 0.001; young adults OR = 1.47, CI:1.14-1.92, p = 0.004) and versus Canada among youth (OR = 1.47, CI:1.35-1.61, p < 0.001), among youth with moderate-to-high mental health symptoms (vs. no/low symptoms, OR = 1.23, CI:1.13-1.35, p < 0.001) and youth who smoked and/or vaped nicotine or formerly used cannabis (vs. never used, all p < 0.05). Among young adults, perceptions did not vary by mental health or nicotine/cannabis use.