title: Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win.
abstract: BACKGROUND
  There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years.
  
  
  OBJECTIVE
  This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions.
  
  
  METHODS
  In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products.
  
  
  RESULTS
  Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.
authors.affiliation: 1Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Berg
authors.forename: Erin
authors.initials: E
authors.lastname: Stratton
authors.forename: Gillian L
authors.initials: GL
authors.lastname: Schauer
authors.forename: Michael
authors.initials: M
authors.lastname: Lewis
authors.forename: Yanwen
authors.initials: Y
authors.lastname: Wang
authors.forename: Michael
authors.initials: M
authors.lastname: Windle
authors.forename: Michelle
authors.initials: M
authors.lastname: Kegler
mesh_terms: D003625:Data Collection; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D012929:Psychological Distance; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000523:psychology; D015144:Southeastern United States / Q000453:epidemiology; D055815:Young Adult
keywords: addiction; health risk; marijuana use; social norms; tobacco use; youth