Health Education Research Advance Access originally published online on June 15, 2004
Health Education Research 2004 19(6):635-643; doi:10.1093/her/cyg089
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Health Education Research Vol.19 no.6, © Oxford University Press 2004; All rights reserved
The role of cannabis in supporting young people's cigarette smoking: a qualitative exploration
Research Unit in Health, Behaviour and Change, School of Clinical Sciences and Community Health, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
E-mail: Gill.Highet{at}ed.ac.uk
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Abstract |
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This paper reports findings from a qualitative study which explores the role of cannabis in young people's lives during their early teenage years. In particular, it focuses on the relationship between cannabis and tobacco-related beliefs and behaviour. Fifty-nine young people of both sexes, aged 13–15, from different socioeconomic backgrounds, and with a wide range of cigarette and cannabis use experience, took part in the study. All were recruited from youth club settings and most were interviewed in self-selected friendship pairs. The paper argues that, while many young people appear to hold predominantly negative views about cigarettes, particularly in relation to their potential to foster dependence, cannabis is often viewed as relatively benign. In spite of these beliefs, for some ‘cannabis-oriented’ young people, their cannabis use appears to support and reinforce their smoking habit. The paper concludes that a coordinated approach to the planning and delivery of services which addresses young people's health risk behaviours is required. Smoking cessation and drugs education practitioners need to break with tradition, and find ways of working more closely together.
This paper reports findings from a qualitative study which explores the role of cannabis in young people's lives during their early teenage years. In particular, it focuses on the relationship between cannabis and tobacco-related beliefs and behaviour. Fifty-nine young people of both sexes, aged 13–15, from different socioeconomic backgrounds, and with a wide range of cigarette and cannabis use experience, took part in the study. All were recruited from youth club settings and most were interviewed in self-selected friendship pairs. The paper argues that, while many young people appear to hold predominantly negative views about cigarettes, particularly in relation to their potential to foster dependence, cannabis is often viewed as relatively benign. In spite of these beliefs, for some ‘cannabis-oriented’ young people, their cannabis use appears to support and reinforce their smoking habit. The paper concludes that a coordinated approach to the planning and delivery of services which addresses young people's health risk behaviours is required. Smoking cessation and drugs education practitioners need to break with tradition, and find ways of working more closely together.
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Cannabis, tobacco and respiratory health
In 2002, the British Home Secretary, David Blunkett, announced his intention to reclassify cannabis from a Class B to a Class C drug, sparking off a heated debate, mostly from a criminal justice perspective, about the likely impact of such a change on young people's behaviour. With the implementation of this change, in January 2004, the terms of the debate have shifted a little to include a greater emphasis on potential health consequences (Advisory Council on the Misuse of Drugs, 2003
). One perspective on this debate highlights the threat that smoking cannabis may pose to health (British Lung Foundation, 2002; Hendry et al., 2003). Advocates of an opposing perspective argue that there is no evidence that cannabis has any notable adverse public health impact in relation to mortality (Andreasson and Allbeck, 1990; Sidney, 2003). In contrast to this debate, the link between tobacco consumption, respiratory health and mortality is now well established (Callum, 1998; Office for National Statistics, 1998). Drawing upon a life-course perspective, a central plank of the government's tobacco control strategy is the reduction of smoking amongst young people (Department of Health, 1998).
The relationship between young people's smoking and cannabis use
Prevalence rates of cannabis use among young Scots remain consistently high (Boreham and Shaw, 2001; Fraser, 2002; Edinburgh Study of Youth Transitions and Crime, 2003). Scotland appears to have higher levels of cannabis use than other parts of the UK, with 60% of boys and 47% of girls aged 15/16 reporting that they had used the drug at some point in their lives. This compares with 42% of boys and 38% of girls in England (Miller and Plant, 1996). A recent review suggests that there is some evidence that gender differences in cannabis use are reducing, particularly among teenagers (West and Sweeting, 2002). The link between young people's tobacco and cannabis use has also been established—most young cannabis users also smoke cigarettes (Jacobsen et al., 2001; Advisory Council on the Misuse of Drugs, 2002; Edinburgh Study of Youth Transitions and Crime, 2003) and for some young people, tobacco can act as a ‘gateway’ to cannabis (US Department of Health and Human Services, 1994; Kozloski et al., 2001). Some recent qualitative studies have added a new dimension to this debate, focusing on young people's perspectives on their health behaviours and rooting these within descriptions of their everyday lives. Findings from these studies show that this ‘gateway’ effect may also operate in reverse, with cannabis introducing some young people to tobacco and subsequently to cigarette smoking (Albutt et al., 1995; Bell et al., 1998; Amos et al., 2004). These studies offer new insights into how young smokers today view cannabis use and how this relates to their own smoking behaviour. Many young people, for example, express a desire to quit smoking, but few want to stop using cannabis. These two behaviours appear to be inextricably linked, particularly for boys who are regular cannabis users and for whom their cannabis use appears to reinforce their cigarette smoking (Amos et al., 2004).
Building on these new insights, this paper will report findings from a qualitative study exploring the role of cannabis in young people's lives during their early teenage years. This study generated contextual data on the meanings and motivations underpinning young people's cannabis use, and also explored aspects of the relationship between participants' cannabis-related beliefs and behaviour, and their tobacco use. This paper will focus on two particular aspects. First, it will discuss how participants related concepts of ‘addiction’, ‘dependence’ and ‘harm’ to their cannabis and smoking behaviours. Second, adding weight to the emerging evidence noted above, it will consider how cannabis use appears to support and sustain the cigarette smoking behaviour of some ‘cannabis-oriented’ young people, i.e. young people whose social lives tend to be cannabis-, rather than alcohol-oriented (Bell et al., 1998). The paper will conclude with a discussion of the implications for the effective delivery of smoking cessation and drugs education for young people.
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Using a purposive sampling approach, 59 young Scots aged 13–15 living in Lothian Region, from different socioeconomic backgrounds, were recruited to the study. Table I describes the interview settings. Participants were also selected on the basis of their cigarette and cannabis use experience, reported in Table II. The participants were recruited from youth clubs. This reflected the researcher's previous professional background and provided a more ‘naturalistic’ setting than school-based studies. The study comprised 30 interviews, of which 21 were paired interviews, five were individual interviews and four were threesomes. A topic guide was used to focus discussion on participants' interests and leisure activities, and on their beliefs about and experiences of cigarette smoking and cannabis use, and the meanings they attach to these behaviours. Borrowing from ethnographic traditions, interview data were supplemented with data generated by other methods, including discussions with youth workers and field notes based on observations within the various settings. A detailed account of the study's methodological approach, in particular the use of the paired interview method, appears in an earlier paper (Highet, 2003
).
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Interviews were tape recorded and fully transcribed, and the transcripts analysed by the researcher using a general ‘grounded theory’ approach (Glaser and Strauss, 1967
). To ensure analytical rigour, the researcher engaged in regular discussions on emerging themes from the descriptive to the analytical stages with her PhD supervisors. The interviews were coded using NVivo and the researcher also worked directly from the transcripts, applying an iterative approach which ensured that previous work and existing theories and concepts were woven into the interpretive process of the data analysis. In the findings section, each interviewee is represented by a pseudonym. The actual age of participants at the time of interview is also provided. The data below relate primarily to participants who reported smoking both cannabis and cigarettes, in this study mainly boys (see Table II).
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Findings |
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Cigarette smoking—young people's concepts of addiction
Many cigarette smokers in this study talked about wanting or intending to give up cigarettes. In most cases, participants experienced trying to give up either as something that they planned to do at some point in the future or as something that had to be attempted on several occasions:
Melanie [15] ‘Cause I mean I really don't plan to be a smoker. I mean, I plan to give up once school's, like, ‘cause I'm going for a year out, so I plan to just give up then. It's just because at the moment, to have the stress of fifth year and have the stress of giving up smoking, I just don't think I could handle it.Bret and others, some as young as 13, clearly experienced trying to stop smoking cigarettes as an intensely physical and emotional experience. The symptoms they described are associated with nicotine withdrawal and imply a physical dependence which makes it very difficult to quit:Int Do you smoke cigarettes as well?
Bruce [15] Yeah, I smoke fags as well.
Bret [15] I'm trying to give up, I mean I've been to the doctor and everything.
Int What, to give up fags?
Bret Yeah, its like I've been to the doctor, right, ‘cause I really want to stop but I mean I can't stop—it's just like that. And that's when I walk into the house and I'm pissed off again with my mum and that's how everything starts up again.
Int Have you ever thought about stopping at all?This extract touches on the social function of cigarette smoking and many accounts were explicit about the social role of smoking; in particular, how this contributes to the difficulties that many young people experience when trying to quit. For some, cigarette smoking was an integral part of their leisure culture; while it was possible to do without cigarettes for relatively long periods of time when outside this context, it was very difficult to sustain this behaviour on returning to it:Neville [13] I've tried stopping—I snapped up 10 fags, 2 minutes later I was crying to get more
Int Were you? What does it feel like if you don't smoke?
Neville Feels weird, you get all distressed and angry. Look at a bit of paper and go off your head.
Int Do you ever see yourself stopping?
Neville I dunno, like.
Nick [14] I can see myself stopping, but like I says if people offer me a fag I would take it.
Neville I couldn't see myself stopping, like.
Int Why's that?
Neville I dunno, its just like I said, I've tried it before, but I get all dizzy and that when I've not had a fag.
Nicol [15] I lasted about 4 or 5 days without a fag. But as soon as I come back and see all them, they're just smoking a fag. And it's, here, have a draw, and that's it, start up again.In some cases, peer influence took a more cynical and deliberate form. Some young people returned to smoking in order to save face or perhaps because it seemed like the easiest option:Int So is it your mates around you still smoking that makes it hard?
Nicol Yeah, if they were to stop, then it'd be easy.
Int You were both saying you feel you're addicted?A common discourse suffusing these accounts is one of ‘wanting’ to give up cigarettes. It is difficult to be certain of the origins of this discourse. Some evidence suggests that many young people do not anticipate the difficulties they may face in trying to quit, especially when they see themselves as ‘social smokers’ (Amos et al., 2004Rose [15] A wee bit, yeah.
Robert [14] I've tried stopping loads of times, but I don't know.
Rose I have stopped a couple of times but they're just like, oh, do you want a draw, and you're just like, no. And they keep on teasing you, blowing smoke and everything on your face. And I just say, oh, give us a draw and then just smoke it, and then you do regret it later.
). Other young people consider it important to quit eventually, but not right now (Balch, 1998). Cigarette smoking clearly fulfils important positive social functions for many young people. For these ‘tobacco-dependent’ smokers, their habit goes beyond a need for nicotine (O'Loughlin et al., 2002; Johnson et al., 2003). Data from the current study show that for some young smokers, both nicotine addiction and peers continuing to smoke are salient issues which are influential to varying degrees in maintaining their smoking behaviour. For many young smokers, giving up cigarettes is an ongoing process that is difficult to achieve, and some seem more confident and determined than others that they will eventually succeed. But how do participants apply these concepts to their cannabis use? The next part of this section will address this issue.
Cannabis use—young people's concepts of addiction and harm
A striking difference between how smokers talked about their cigarette smoking behaviour, on the one hand, and their cannabis use, on the other, was their use of a ‘quit discourse’ [see also (Amos et al., 2004)]. This was commonly applied to their tobacco use, but, in contrast, was entirely absent from accounts of their cannabis use. Many young people seemed to view these two behaviours in very different ways. Some portrayed their cannabis use as youthful experimentation:
Int Do you see yourself still using it, like, in years to come, or what do you think?Others made a more explicit distinction between the addictive quality of cigarettes and the relatively benign status of cannabis:Neil [15] No.
Norrie [15] I'll have a job and be occupied, well I think I will.
Neil Same here.
Norrie And not even think about it.
Int Have you ever thought about stopping using hash?Some participants, both cannabis users and non-users, viewed cigarettes primarily in terms of their potential to foster dependency, whilst cannabis was something that simply got you ‘high’:Brian [15] Hash isn't, that, like, addictive, it's just something, like, you do if you're bored. ‘Cause, I could just go, no, I've stopped, and I wouldn't take it again.
Int So it's just kind of a boredom, thing?
Brian Yeah.
Int Some people have said to me it's kind of different, it's not the same as a cigarette?Drawing upon the current public debate about the medical use of cannabis, many young people referred to the therapeutic qualities of cannabis. However, an unexpected finding was the view that cannabis can somehow undo some of the damage caused by cigarette smoking:Nicol [15] Well, a cigarette, you take a draw of it, and just do it ‘cause you're addicted, but with hash, it's like a high, and it's like, stronger.
Int What's the same, what's different about these two things?
Norrie [15] Well, smoking fags doesn't really do anything to you except.
Nash [15] You can get addicted to them, and calms your nerves.
Norrie And hash, like, gets you stoned.
Int You were saying that you thought cigarettes were more dangerous?Consistent with the findings of another recent study on young people's drug use (McIntosh et al., 2003Norman [14] Yeah.
Int How come?
Norman Because you see it on the news and that. Cigarettes is more danger to getting lung cancer than hash. Because hash is diluting the tobacco down.
Int Diluting, yeah?
Norman Yeah, if you take a cigarette, right, and then you smoke joint straight after it, all the smoke from the cigarette gets killed and that, on the way down from the hash smoke.
), family members, often older siblings, were the source of young people's cannabis-related beliefs:Robert [14] Smoking hash is better for you than smoking actual normal fags, well folk say so.These data suggest that many young cannabis users, and some non-users, hold very different views about tobacco and cannabis. Cigarette smoking is viewed as an addictive habit, one which they would like to give up if only they could. Cannabis, on the other hand, does not foster dependency, is part of youthful experimentation, and produces the desirable effect of getting you ‘high’. Its ‘benign’ status is further enhanced by the myth, albeit tentatively held in some cases, that cannabis has the potential to undo some of the damage caused by cigarette smoking. Given these beliefs, it is somewhat ironic that for some participants who use cannabis regularly, their cannabis use appears to support and sustain their cigarette smoking. It is to these data that the next section now turns.Int Why do you think that is?
Rose [15] ‘Cause it clears your airways or something, I don't know, that's what I got told.
Int Where did you hear that from?
Rose My brother, that's what he says to me.
The role of cannabis in supporting young men's cigarette smoking
This study provides further evidence that for some ‘cannabis-oriented’ participants, mainly boys, their cannabis use appeared to encourage their smoking habit. Although some boys expressed ambivalent feelings about smoking cigarettes, they were reluctant to give them up because of their role in supporting their cannabis use:
Bruce [15] I don't like smoking, well I like smoking fags but I don't like smoking fags, it's shite. I'm always smoking (cigarettes). All my mates smoke ‘cause smokers are always equipped, you've always got a lighter for making hash and if we've got fags we don't need to go out and buy fags.Bruce's ambiguous remark perhaps implies a ‘love–hate’ relationship with cigarettes. While he does not enjoy certain aspects of this behaviour, as long as cigarettes continue to be useful to his cannabis habit, he will continue using tobacco, in spite of his mixed feelings. Cannabis could also introduce some young people, against their better judgement, to tobacco and subsequently to cigarettes:
Int So did you smoke cigarettes before you smoked hash?Although both Neal and his interview partner had tried to stop smoking cigarettes, they had abandoned their efforts, arguing that it is pointless trying to quit smoking, since a joint also contains the constituents of a cigarette:Neal [14] No—I started smoking hash first, then I started—I didn't like smoking fags, I didn't like fags, but then I just started smoking them.
Nathan [14] I tried giving up smoking, stopping, a week ago, eh?Other accounts suggested that cigarettes could also be used as a substitute when cannabis is not available:Neal [14] I stopped, I stopped for about a month.
Nathan But then we just started again.
Int How come you both started again?
Neal It's ‘cause when you're smoking the hash, the fag's still in the hash, so I don't really see the difference.
Barry [13] I had hash before I even had a draw of a fag, but I've had a joint and that, but then I tried fags.For many non-cannabis users, the idea that young people may start with cannabis and progress to cigarettes seemed unusual. Most cannabis users, however, while not sharing this progression pattern themselves, either talked about knowing people who have progressed from cannabis to cigarettes or indicated that this pattern of usage made sense to them:Brad [13] I had joints before I started smoking—when I couldn't get the hash, I smoked fags.
Barry [13] There was lot of folk smoke hash at the school that didn't smoke fags and sometimes you'll see them smoking a fag because they haven't got any hash or they can't get any hash.A prior dislike of cigarettes did not prevent some young people from beginning to smoke cigarettes as a substitute when cannabis was not available. Some participants understood this in terms of nicotine dependence:
Robert [14] I know somebody that never smoked and now they smoke. He always smoked joints really funny and I only seen for the first time, I think it was last Friday, here, and he was smoking a fag, and I thought that was really strange, that he hated smoking before it, and now that he had joints and he was getting the nicotine, he started to smoke fags.Other young people understood the substitute function of cigarettes in social terms rather than linking it with nicotine dependence:Int Do you think sometimes folk start with hash and then...
Nicol [15] Yeah, well, think about it, you put in a fag in a joint, and nicotine's addictive, so if you smoke hash but often you've not got a joint, you'll just take a fag and then you'll just start smoking.
Rob [13] Yeah, I know a couple of folk.So, some young cannabis users smoked cigarettes as a substitute when cannabis was not available. Others implied that being a cigarette smoker offers another advantage—that of conserving cannabis supplies:Ray [13] David.
Rob Yeah, he just smoked hash and he hated the smoke but now he's smoking fags.
Int Why do you think he did that?
Rob ‘Cause you get bored with not smoking hash all the time. You're not allowed to smoke, so you just buy fags.
Int Right, like a substitute or something?
Rob Yeah.
Nathan [14] It's just like if you're wanting to hang on to a little bit and you've got fags, you can keep some.Neal [14] Just leave a bit for tomorrow morning or something, or a bit for your sleep. That's what's good about it, puts you straight to sleep—no bother.
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Tobacco, cannabis and alcohol are now well established as the main constituents of a constellation of youthful ‘risk’ behaviours (ISD Scotland, 2002; Edinburgh Study of Youth Transitions and Crime, 2003
). The findings reported in this study contribute to our knowledge in this area by adding to the growing evidence that cannabis may encourage some non-smokers to use tobacco and subsequently take up cigarette smoking. The data also provide new insights into the relationship between cannabis and existing cigarette smoking behaviour. It would appear, for example, that cigarettes are sometimes used as a substitute when cannabis is not available and as a way of conserving cannabis supplies. Being a cigarette smoker also ‘equips’ some young people with the paraphernalia required to have a cannabis session and in this respect their cigarette smoking is an integral part of their cannabis use. These findings apply predominantly to boys and may reflect gender differences in how cigarette smoking behaviour is shaped (Michell and Amos, 1997; Plumridge et al., 2002). They may also reflect an association between cannabis and male street-based leisure cultures (Pavis and Cunningham-Burley, 1999). This study has also shown that many young people hold very different views about tobacco and cannabis, particularly in relation to concepts of ‘addiction’, ‘dependence’ and ‘harm’. While cigarettes are generally portrayed in a very negative light, cannabis is regarded by some young people as not only benign, but also instrumental in reversing the damage caused by cigarette smoking.
Implications for health promotion policy and practice
Reducing smoking in young people is central to tobacco control and specific cessation services for young people have now been established (Health Education Board for Scotland, 2002). Little attention, however, has been paid to the relationship between smoking and cannabis in young people (Amos et al., 2004). Most health education programmes treat smoking and drugs separately, taking no account of the potential for cannabis to introduce some young people to tobacco nor its role in supporting and reinforcing smoking in some young people. In an attempt to address this gap, a recent Scottish conference on tobacco control and young people included a workshop on cannabis and tobacco (Scottish Tobacco Control Alliance, 2003). Delegates reached a consensus on the importance of adapting smoking cessation services to include people who use cannabis and advocated a move towards joint planning of services for smoking, alcohol and illicit drugs in order more effectively to address young people's risk behaviours. The findings of an ongoing longitudinal study, the Edinburgh Study of Youth Transitions and Crime, also supports a move towards a more coordinated approach (Edinburgh Study of Youth Transitions and Crime, 2003). In the context of smoking cessation such a move would clearly benefit from the provision of resources which jointly address tobacco and cannabis use. Most resources target one behaviour in isolation, e.g. the Aspire magazine has recently been developed in Scotland to support young people's smoking cessation efforts (Health Education Board for Scotland, 2001). This resource includes a section on potential barriers to cessation, yet fails to mention cannabis. Similarly, many current leaflets target young cannabis users, but fail to address issues around smoking cessation (Scottish Drugs Forum, 1996; Lifeline, 2000; HIT, 2002; Scottish Executive, 2002). One resource which does address both behaviours together is the Fags and Hash leaflet (ASH Scotland, 2002). Further development of this resource, to include issues around cessation, is planned. Findings from this study support the continuing development of initiatives such as this, which acknowledge the relationship between young people's cannabis and tobacco use.
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Conclusion |
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Given the potential role that cannabis plays in supporting and sustaining smoking behaviour in some young people, it is important both to re-assess how smoking cessation services are currently delivered to young people, and to develop further our understanding of the nature and extent of the relationship between young people's cannabis and tobacco use. This is not without its challenges. It will require researchers and practitioners from smoking cessation and drugs education breaking with tradition and finding ways of working together. It may also involve addressing politically sensitive issues, e.g. developing ‘harm reduction’ approaches to cannabis which do not involve smoking tobacco. Nonetheless, if cannabis is a potential barrier to some young people quitting smoking, it is incumbent upon health planners and practitioners to address this. At a very practical level, and as a first step, this requires smoking cessation workers to discuss cannabis use with their young clients in order to assess its likely impact on their efforts to quit smoking.
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Acknowledgments |
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I would like to thank the young people who participated in the study and their youth workers. I am also grateful to Dr Amanda Amos and Professor Stephen Platt for their guidance and support in the writing of this paper. The study was funded through an MRC studentship in the School of Clinical Sciences and Community Health, University of Edinburgh.
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Advisory Council on the Misuse of Drugs (2002) The Classification of Cannabis Under the Misuse of Drugs Act 1971. Home Office, London.
Advisory Council on the Misuse of Drugs (2003) The Misuse of Drugs Act 1971 (Modification) (No. 2) Order 2003. Home Office, London.
Albutt, H., Amos, A. and Cunningham-Burley, S. (1995) The social image of smoking among young people in Scotland. Health Education Research, 10, 443–454.
Amos, A., Wilshire, S., Bostock, Y., Haw, S. and McNeill, A. (2004) ‘You can't go without a fag...you need it for your hash’—a qualitative exploration of smoking, cannabis and young people, Addiction, 99, 77–81.[CrossRef][ISI][Medline]
Andreasson, S. and Allbeck, P. (1990) Cannabis and mortality among young men: a longitudinal study of Swedish conscripts. Scandinavian Journal of Social Medicine, 18, 9–15.[ISI][Medline]
ASH Scotland (2002) Fags and Hash. ASH Scotland, Edinburgh. Available: www.ashscotland.org.uk/quit/tobacco.html.
Balch, G.I. (1998) Exploring perceptions of smoking cessation among high school smokers: input and feedback from focus groups. Preventative Medicine, 27, A55–A63.[CrossRef][ISI][Medline]
Bell, R., Pavis, S., Cunningham-Burley, S. and Amos, A. (1998) Young men's use of cannabis: exploring changes in meaning and context over time. Drugs: Education, Prevention and Policy, 5, 141–155.
Boreham, R. and Shaw, A. (2001) Smoking, Drinking and Drug Use among Young People in Scotland in 2000. The Stationery Office, Edinburgh.
British Lung Foundation (2002) Cannabis and the Lungs. British Lung Foundation, London. Available: http://www.lunguk/org/news/a_smoking_gun.pdf.
Callum, C. (1998) The UK Smoking Epidemic—Deaths in 1995. Health Education Authority, London.
Department of Health (1998) Smoking Kills: A White Paper on Tobacco. The Stationery Office, London.
Edinburgh Study of Youth Transitions and Crime (2003) Newsletter Summer 2003. ESYTC, University of Edinburgh.
Fraser, F. (2002) Drug Misuse in Scotland: Findings from the 2000 Crime Survey. Scottish Executive Central Research Unit, Edinburgh.
Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine, Chicago, IL.
Health Education Board for Scotland (2001) Aspire. HEBS/ASH Scotland, Edinburgh.
Health Education Board for Scotland (2002) Young people. HEBS Update, 66, 7.
Hendry, J.A., Oldfield, W.L.G. and Kon, O.M. (2003) Comparing cannabis with tobacco. British Medical Journal, 326, 942–943.
Highet, G. (2003) Cannabis and smoking research: interviewing young people in self-selected friendship pairs. Health Education Research 18, 108–118.
HIT (2002) Cannabis Booklet (Updated Text). HIT Publications (formerly Mersey Drug Training and Information Centre), Liverpool.
Johnson, J.L., Bottorff, J.L., Moffat, B., Ratner, P.A., Shoveller, J.A. and Lovato, C.Y. (2003) Tobacco dependence: adolescents' perspectives on the need to smoke. Social Science and Medicine, 56, 1481–1492.
Kozloski, L.T., Henningfield, J.E. and Brigham, J. (2001) Cigarettes, Nicotine and Health. Sage, London.
Lifeline (2000) Everything You Wanted to Know About Cannabis But Were Afraid to Ask. Lifeline, Manchester.
McIntosh, J., MacDonald, F. and McKeganey, N. (2003) The initial use of drugs in a sample of pre-teenage schoolchildren: the role of choice, pressure and influence. Drugs: Education, Prevention and Policy, 10, 147–158.[CrossRef]
Michell, L. and Amos, A. (1997) Girls, pecking order and smoking. Social Science and Medicine, 44, 1861–1869.
Miller, P.M. and Plant, M. (1996) Drinking, smoking and illicit drug use among 15 and 16 year olds in the United Kingdom. British Medical Journal, 313, 394–397.
Office for National Statistics (1998) Population Trends No. 93. Stationery Office, London.
O'Loughlin, J., Kishchuk, N., DiFranza, J., Tremblay, M. and Paradis, G. (2002) The hardest thing is the habit: a qualitative investigation of adolescent smokers' experience of nicotine dependence. Nicotine and Tobacco Research, 4, 201–209.
Pavis, S. and Cunningham-Burley, S. (1999) Male youth street culture: understanding the context of health-related behaviours. Health Education Research, 14, 583–596.
Plumridge, E.W., Fitzgerald, L.J. and Abel, G.M. (2002) Performing coolness: smoking refusal and adolescent identities. Health Education Research, 17, 167–179.
Scottish Drugs Forum (1996) The Survivors' Guide to Drugs and Clubbing. Scottish Drugs Forum, Edinburgh.
Scottish Executive (2002) Cannabis: Know the Score. HMSO, Edinburgh.
Scottish Tobacco Control Alliance (2003) Tobacco and young people: towards a smoke-free generation. Presented at the STCA Conference, Edinburgh.
Sydney, S. (2003) Comparing cannabis with tobacco—again. British Medical Journal 327, 635–636.
US Department of Health and Human Services (1994) Preventing Tobacco Use Among Young People: A Report of the Surgeon General. USDHHS/CDC, Atlanta, GA.
West, P. and Sweeting, H. (2002) The Health of Young People in Scotland: Quantitative Dimensions. MRC Social and Public Health Sciences Unit, University of Glasgow.
Received on December 2, 2003; accepted on March 9, 2004
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