Growing Public Perception That Cannabis Is Safer Than Tobacco

Pauline Anderson

September 07, 2023


Results of a national survey show that despite a lack of data, many adults in the United States believe daily use of cannabis is safer than tobacco, a trend that's growing over time.


  • While aggressive campaigns have led to a dramatic reduction in the prevalence of cigarette smoking and created safer smoke-free environments, regulation governing cannabis — which is associated with some health benefits but also many negative health outcomes — has been less restrictive.

  • The study included a nationally representative sample of 5035 mostly White US adults, mean age 53.4 years, who completed three online surveys between 2017 and 2021 on the safety of tobacco and cannabis.

  • In all three waves of the survey, respondents were asked to rate the safety of smoking one marijuana joint a day to smoking one cigarette a day, and of second-hand smoke from marijuana to that from tobacco.

  • Respondents also expressed views on the safety of second-hand smoke exposure (of both marijuana and tobacco) on specific populations, including children, pregnant women, and adults (ratings were from "completely unsafe" to "completely safe").

  • Independent variables included age, sex, race, ethnicity, education level, annual income, employment status, marital status, and state of residence.


  • There was a significant shift over time toward an increasingly favorable perception of cannabis; more respondents reported cannabis was "somewhat safer" or "much safer" than tobacco in 2021 than 2017 (44.3% vs 36.7%; P < .001, and more believed second-hand smoke was somewhat or much safer for cannabis vs tobacco in 2021 than in 2017 (40.2% vs 35.1%; P < .001).

  • More people endorsed the greater safety of second-hand smoke from cannabis vs tobacco for children and pregnant women, and these perceptions remained similar over the study period.

  • Younger and unmarried individuals were significantly more likely to move toward viewing smoking cannabis as safer than cigarettes, but legality of cannabis in respondents' state of residence was not associated with change over time, suggesting the increasing perception of cannabis safety may be a national trend rather than a trend seen only in states with legalized cannabis.


"Understanding changing views on tobacco and cannabis risk is important given that increases in social acceptance and decreases in risk perception may be directly associated with public health and policies," the investigators write.


The study was conducted by Julia Chambers, MD, Department of Medicine, University of California San Francisco (UCSF), and colleagues. It was published online August 11, in JAMA Network Open.


The generalizability of the study may be limited by nonresponse and loss to follow-up over time. The wording of survey questions may have introduced bias in respondents. Participants were asked about safety of smoking cannabis joints vs tobacco cigarettes and not to compare safety of other forms of smoked and vaped cannabis, tobacco, and nicotine.


The study received support from the California Tobacco-Related Disease Research Program. Chambers has no relevant conflicts of interest; author Katherine J. Hoggatt, PhD, MPH, Department of Medicine, UCSF, reported receiving grants from the Veterans Health Administration during the conduct of the study and grants from the National Institutes of Health, Rubin Family Foundation, and Veterans Health Administration outside the submitted work.

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