12 May Adolescents View Cannabis as Less Harmful Than Alcohol and Tobacco — New California Survey Data

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MedicalResearch.com Interview with:

Prof. Shu-Hong Zhu

Shu-Hong Zhu, Ph.D.
Professor of Family Medicine and Public Health and
Director of the Center for Research and Intervention in Tobacco Control (CRITC)
University of California, San Diego

MedicalResearch.com: What is the background for this study?

Response: Cannabis use in the U.S. has steadily increased over recent decades. As use rates increased, perceptions that cannabis use is harmful have trended in the opposite direction.

Declining harm perceptions in the broader population are concerning in part because of their influence on adolescents. Regular cannabis use during adolescents can negatively impact overall functioning, cognition, and educational achievement. It can lead to depression, psychosis, and suicidality. If young people don’t perceive cannabis as harmful, they are more likely to use it and suffer these effects.

The purpose of this study was to investigate the extent to which adolescents view the everyday and occasional use of cannabis as harmful, and to compare their perceptions of cannabis to their perceptions of alcohol, cigarettes, and nicotine vapes. It used data from over 160,000 students who took the 2019−2020 California Student Tobacco Survey and over 16,000 who took the 2024 California Youth Tobacco Survey.

MedicalResearch.com: What are the main findings?

Response:  We found that adolescents in the sample perceived cannabis as significantly less harmful than alcohol and tobacco. In the 2019−2020 survey, about 67% of adolescents considered regular cannabis use to be harmful, compared to 78% for alcohol, 85% for nicotine vapes, and 93% for cigarettes. Harm perceptions for occasional use were lower across the board, but cannabis was still regarded as least harmful. The 2024 survey data showed a similar pattern, suggesting that adolescents’ low perceptions of cannabis-related risk were consistent over time.

Consistent with previous research showing that peers influence adolescent substance use, the study also found that peers influence adolescent harm perceptions. Students whose peers used a substance tended to view the substance as less harmful than those whose peers did not use it. The gap between these two was widest for cannabis, suggesting that adolescent harm perceptions are more subject to peer influence for cannabis use than for alcohol or tobacco use.

Finally, the study found that for alcohol and tobacco, harm perceptions generally increased with age, whereas for cannabis they declined with age.

MedicalResearch.com: How do you explain harm perceptions for cannabis declining with age during adolescence?

Response:  In one way, it was not surprising that adolescents’ harm perceptions regarding cannabis use declined as they got older, because all substance use increases with age during adolescence and harm perceptions tend to decline as use increases. But the fact that harm perceptions for alcohol and tobacco had a very different trajectory suggests that social norms were at play. For some time now, tobacco has been falling out of public favor, alcohol consumption has also declined recently, but cannabis has been gaining favor. Changes in adolescents’ harm perceptions as they age may simply suggest a growing alignment with social norms in the general population, where cannabis use is increasingly seen as low-risk and socially acceptable.

Another possible explanation for the age-related findings is that students may have absorbed more negative messaging about alcohol and tobacco, increasing their harm perceptions for these substances over time. They may not have absorbed as much negative messaging about cannabis, or the messages they did absorb may have been largely pro-cannabis. 

MedicalResearch.com: What should readers take away from your report?

Response: In states like California that have legalized both medical and recreational cannabis, efforts to educate adolescents about the potential harms of cannabis use may not be robust enough to counter the pro-cannabis messaging they receive from social media and the wider environment. The finding that adolescents in the state view cannabis as significantly less harmful than alcohol, cigarettes, and nicotine vapes highlights the need for education and prevention messaging to increase the perception among adolescents that cannabis use is harmful. Harm perceptions are important because they protect against use.

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: Given the cross-sectional nature of the study, additional research is needed to check for confounders and the intersection of adolescents’ harm perceptions and substance use histories. Future research should also examine whether cannabis harm perceptions vary by mode of cannabis use (i.e., smoking, vaping, eating, drinking, or dabbing), something this study did not explore.

Citation:
Deepti Agarwal, Jijiang Wang, Shuwen Li, Christopher M. Anderson, Shu-Hong Zhu,
Adolescents view cannabis as less harmful than cigarettes, nicotine vapes, and alcohol: Findings from two California school surveys,
Drug and Alcohol Dependence, 2026, 113155, ISSN 0376-8716,
https://doi.org/10.1016/j.drugalcdep.2026.113155.

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Last Updated on May 12, 2026 by Marie Benz MD FAAD