Shifting Perceptions: One Study Analyzes Views on Cannabis and Tobacco Smoke Safety Over Time

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A recently published study tracked American adults’ opinions over several years on smoking cannabis compared to smoking tobacco.

Published August 11, 2023 in the journal JAMA Network Open, a study titled “Perceptions of Safety of Daily Cannabis vs Tobacco Smoking and Secondhand Smoke Exposure, 2017-2021” surveyed thousands of adults and how their views on smoking and safety changed over time (1). The online survey was administered in 2017, 2020, and 2021 and completed by 5035 adults. The Introduction of the study cited studies and recent policies on both cannabis and tobacco smoking as background information for the study (1).

“This study found that US adults increasingly perceived daily smoking and secondhand exposure to cannabis smoke as safer than tobacco smoke from 2017 to 2021,” the researchers concluded (1). More than one third responded that they felt daily cannabis smoking was safer than daily tobacco smoking (1). Participants who were younger or not married, the study found, were more likely to move toward a more favorable view over time on the safety of cannabis (1).


“Given that these views do not reflect the existing science on cannabis and tobacco smoke, the findings may have important implications for public health and policy as the legalization and use of cannabis increase,” researchers stated (1). “These findings suggest that public health efforts may be necessary to educate the public on potential risks and curb the increasing social acceptance of cannabis smoke exposure, similar to past education about secondhand tobacco smoke.”

The lead author for the study, Dr. Beth Cohen, professor of medicine at the University of California, San Francisco, explained safety concerns around smoking (2). “When you burn something, whether it is tobacco or cannabis, it creates toxic compounds, carcinogens, and particulate matter that are harmful to health,” she stated (2). “It’s the combustion that’s the problem, so this idea that because cannabis is ‘natural’ burning and inhaling it is fine is just wrong.”

“I am not anti-cannabis, I just want people to make informed decisions,” Dr. Cohen also explained (2). “Even if we do more research and find out that cannabis smoke is less harmful than tobacco smoke, that still doesn’t mean it’s safe.”

The National Organization for the Reform of Marijuana Laws (NORML) also commented on the study’s statements (3). “Although the study’s lead author criticized Americans’ changing perceptions toward cannabis, numerous scientific studies reinforce the fact that cannabis smoke exposure poses far fewer risks to health than does tobacco,” stated NORML (3). “For example, longitudinal studies show that cannabis smoking, even long-term, is not associated with an increased risk of either lung cancer, COPD, or other significant adverse effects on pulmonary function…Other studies indicate that cannabis smoke and tobacco smoke are not equally carcinogenic and that subjects who exclusively smoke cannabis possess a reduced level of exposure to harmful toxicants and carcinogens than do those who smoke tobacco cigarettes, (3).”


  1. Chambers, J.; Keyhani, S.; Ling, P. M.; Hoggatt, K. J.; Hasin, D.; Nguyen, N.; Woods, A.; Ryder, A.; Cohen, B. E. Perceptions of safety of daily cannabis vs tobacco smoking and secondhand smoke exposure, 2017-2021. JAMA Network Open 2023, 6 (8) DOI: 10.1001/jamanetworkopen.2023.28691.
  2. LaMotte, S. Many Americans wrongly believe exposure to marijuana smoke is safer than tobacco, study finds (accessed Aug 16, 2023).
  3. Survey highlights changing perceptions regarding cannabis and tobacco (accessed Aug 16, 2023).