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Young people in particular are smoking cannabis unaware that each cannabis cigarette increases their chances of developing lung cancer by as much as an entire packet of 20 tobacco cigarettes. The average puff on a cannabis cigarette is two-thirds larger than a tobacco cigarette

Opponents of tobacco21 might argue that the spike was caused by the age limit increase, and that some studies lend credibility to that idea as restrictions on rarer forms of nicotine consumption, such as e-cigarettes, tend to push people toward combustible cigarettes, which are the most widely available tobacco product.[9] Tobacco21 advocates could point out that Needham was the only town that did not see a spike in youth smoking between 2014 and 2016