Rachel Barry and Stanton Glantz argue that a public health framework that prioritizes public health over business interests should be used by US states and countries that legalize retail marijuana.

Aims To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. Design Semi-structured qualitative interviews. Setting Denver, Colorado, USA. Participants Thirty-two young adults (18-26 years old) who used tobacco/marijuana/vaporizers. Measurements Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. Findings Young adults evaluated harms and benefits using five dimensions: (1) Combustion – smoking was considered more harmful than non-combustible products (e.g., e-cigarettes, vaporizers, and edibles); (2) Potency – edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of THC (tetrahydrocannabinol); (3) Chemicals – products containing chemical additives were seen as more harmful than “pure” or “natural” plant products; (4) Addiction – participants recognized physiological addiction to nicotine, but primarily talked about psychological or lifestyle dependence on marijuana; (5) Source of knowledge – personal experiences, warning labels, campaigns, the media, and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. Conclusions Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as “natural” and “pure” in the promotion or packaging of tobacco and marijuana products might be misleading.

Policymakers and public health advocates must be aware that the tobacco industry or comparable multinational organizations (eg, food and beverage industries) are prepared to enter the marijuana market with the intention of increasing its already widespread use. In order to prevent domination of the market by companies seeking to maximize market size and profits, policymakers should learn from their successes and failures in regulating tobacco.

The movement to legalize and regulate retail marijuana is growing. We examined legislation and regulations in the first 4 states to legalize recreational marijuana (Colorado, Washington, Oregon, and Alaska) to analyze whether public health best practices from tobacco and alcohol control to reduce population-level demand were being followed. Only between 34% and 51% of policies followed best practices. Marijuana regulations generally followed US alcohol policy regarding conflict of interest, taxation, education (youth-based and problematic users), warning labels, and research that does not seek to minimize consumption and the associated health effects. Application of US alcohol policies to marijuana has been challenged by some policy actors, notably those advocating public health policies modeled on tobacco control. Reversing past decisions to regulate marijuana modeled on alcohol policies will likely become increasingly difficult once these processes are set in motion and a dominant policy framework and trajectory becomes established. Designing future marijuana legislation to prioritize public health over business would make it easier to implement legalization of recreational marijuana in a way that protects health.

E‐cigarettes are new products that are generating policy issues, including youth access and smokefree laws, for local and state governments. Unlike with analogous debates on conventional cigarettes, initial opposition came from e‐cigarette users and retailers independent of the multinational cigarette companies. After the cigarette companies entered the e‐cigarette market, the opposition changed to resemble long‐standing industry resistance to tobacco control policies, including campaign contributions, lobbying, and working through third parties and front groups. As with earlier efforts to restrict tobacco products, health advocates have had the most success at the local rather than the state level. Context E‐cigarettes entered the US market in 2007 without federal regulation. In 2009, local and state policymakers began identifying ways to regulate their sale, public usage, taxation, and marketing, often by integrating them into existing tobacco control laws. Methods We reviewed legislative hearings, newspaper articles, financial disclosure reports, NewsBank, Google, Twitter, and Facebook and conducted interviews to analyze e‐cigarette policy debates between 2009 and 2014 in 4 cities and the corresponding states. Findings Initial opposition to local and state legislation came from e‐cigarette users and retailers independent of the large multinational cigarette companies. After cigarette companies entered the e‐cigarette market, e‐cigarette policy debates increasingly resembled comparable tobacco control debates from the 1970s through the 1990s, including pushing pro‐industry legislation, working through third parties and front groups, mobilizing “grassroots” networks, lobbying and using campaign contributions, and claiming that policy was unnecessary due to “imminent” federal regulation. Similar to the 1980s, when the voluntary health organizations were slow to enter tobacco control debates, because they saw smoking restrictions as controversial, these organizations were reluctant to enter e‐cigarette debates. Strong legislation passed at the local level because of the committed efforts of local health departments and leadership from experienced politicians but failed at the state level due to intense cigarette company lobbying without countervailing pressure from the voluntary health organizations. Conclusions Passing e‐cigarette regulations at the state level has become more difficult since cigarette companies have entered the market. While state legislation is possible, as with earlier tobacco control policymaking, local governments remain a viable option for overcoming cigarette company interference in the policymaking process.