'You can't go without a fag ... you need it for your hash' - a qualitative exploration of smoking, cannabis and young people

Aims To examine the relationship between smoking tobacco and cannabis use among smokers in their mid-to-late teens.

Design and participants Two qualitative studies in Scotland. One study used semistructured paired interviews involving 99 16-19-year-old smokers, the other comprised eight focus groups involving 46 15-16-year-old smokers.

Measurement The interviews and focus groups explored the role and meaning of smoking in the participants' lives, smoking histories and future cessation intentions and how these related to other aspects of their lives, particularly cannabis use.

Findings Cannabis use was regarded as an important and enjoyable aspect of many of the participants' lives. Importantly, cannabis use and cigarette smoking were linked inextricably. Several reported how smoking joints had been a I gateway' to smoking cigarettes. While most wanted to quit smoking cigarettes, cannabis use reinforced their cigarette smoking and few wanted to stop using cannabis.

Conclusion National studies need to be conducted to examine how widespread the problem identified is and tobacco control initiatives and smoking cessation treatment services need to consider urgently how to overcome the barrier that a desire on the part of young people to continue cannabis smoking poses to achieving a reduction in tobacco use.