Cannabis use is more common among nicotine users than non-users. This study characterized concurrent use of nicotine and cannabis (“co-use”) among 12,064 youth aged 16–19 years residing in Canada, the United States, and England in 2017.
Methods
Data were from the ITC Youth Tobacco & Vaping Survey (Wave 1). Seven modes of cannabis delivery (MOD) were characterized by country of residence and past 30-day use of combusted tobacco and electronic cigarettes. Weighted multivariable regression models were fitted to assess the correlates of co-use and each cannabis MOD.
Results
Seventy percent of cannabis users reported nicotine use. Co-users exhibited behavioral and demographic differences compared to exclusive users of either substance. “Smoking cannabis without tobacco” was the most popular form of use (78%). Use of nicotine-containing e-cigarettes was associated with “using an e-cigarette to vape cannabis oil/liquid” (aOR: 4.96, 95%CI: 2.23–11.06). Combustible tobacco use was associated with “smoking cannabis with tobacco in a joint/blunt” (aOR: 2.93, 95%CI: 1.89–4.56). Country-level differences were detected.
Conclusions
Nicotine use is substantial among cannabis users, and associations exist between modes of delivery for both drugs. Results underscore the importance of studying cannabis and nicotine use concurrently, and the need to address the use of both substances in developing interventions for youth users.
United Nations Office on Drugs and Crime. World Drug Report 2018: Drugs and Age - Drugs and Associated Issues among Young People and Older People. Vienna, Austria: UNODC; 2019.
2.
National Academies of Science, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: NASEM;2017.
3.
YuanM, CrossSJ, LoughlinSE, LeslieFM.Nicotine and the adolescent brain. J Physiol.2015;593(16):3397–3412.
4.
GentzkeAS, CreamerM, CullenKA, . Vital signs: tobacco product use among middle and high school students - United States, 2011–2018. MMWR Morb Mortal Wkly Rep.2019;68(6):157–164.
5.
ReidJH, TariqU, BurkhalterR, RynardVL, DouglasO.Tobacco Use in Canada: Patterns and Trends, 2019 Ed. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo; 2019.
6.
BauldL, MacKintoshAM, EastwoodB, . Young people's use of e-cigarettes across the United Kingdom: findings from five surveys 2015-2017. Int J Env Res Pub Health.2017;14(9):973.
7.
Marijuana Business Daily. Marijuana industry statistics, data and charts. Marijuana Business Daily Web site.https://mjbizdaily.com/category/charts/. Published 2019. Accessed May 18, 2019.
8.
SchauerGL, PetersEN.Correlates and trends in youth co-use of marijuana and tobacco in the United States, 2005–2014. Drug Alcohol Depend.2018;185:238–244.
9.
MeierE, HatsukamiDK.A review of the additive health risk of cannabis and tobacco co-use. Drug Alcohol Depend.2016;166:6–12.
10.
PetersEN, SchwartzRP, WangS, O'GradyKE, BlancoC.Psychiatric, psychosocial, and physical health correlates of co-occurring cannabis use disorders and nicotine dependence. Drug Alcohol Depend.2014;134:228–234.
11.
RamoDE, LiuH, ProchaskaJJ.Tobacco and marijuana use among adolescents and young adults: a systematic review of their co-use. Clin Psychol Rev.2012;32(2):105–121.
12.
JonesHJ, GageSH, HeronJ, . Association of combined patterns of tobacco and cannabis use in adolescence with psychotic experiences. JAMA Psychiatry.2018;75(3):240.
13.
SmithDM, O'ConnorRJ, WeiB, TraversM, HylandA, GoniewiczML.Nicotine and toxicant exposure among concurrent users (“co-users”) of tobacco and cannabis. Nicotine Tob Res.2019:pii: ntz122. doi:10.1093/ntr/ntz122.
14.
AgrawalA, BudneyAJ, LynskeyMT.The co-occurring use and misuse of cannabis and tobacco: a review. Addiction.2012;107(7):1221–1233.
15.
GiovencoDP, Miller LoEJ, LewisMJ, DelnevoCD.“They're pretty much made for blunts”: product features that facilitate marijuana use among young adult cigarillo users in the united states. Nicotine Tob Res.2017;19(11):1359.
16.
KongG, BoldKW, SimonP, CamengaDR, CavalloDA, Krishnan-SarinS.Reasons for cigarillo initiation and cigarillo manipulation methods among adolescents. Tob Regul Sci.2017;3(2):48–58.
17.
TriversKF, PhillipsE, GentzkeAS, TynanMA, NeffLJ.Prevalence of cannabis use in electronic cigarettes among us youth. JAMA Pediatr.2018;172(11):1097–1099.
18.
MoreanME, KongG, CamengaDR, CavalloDA, Krishnan-SarinS.High school students’ use of electronic cigarettes to vaporize cannabis. Pediatrics.2015;136(4):611–616.
19.
RussellC, RuedaS, RoomR, TyndallM, FischerB.Routes of administration for cannabis use - basic prevalence and related health outcomes: a scoping review and synthesis. Int J Drug Policy.2018;52:87–96.
20.
BelangerRE, AkreC, KuntscheE, GmelG, SurisJC.Adding tobacco to cannabis–its frequency and likely implications. Nicotine Tob Res.2011;13(8):746–750.
21.
FixBV, SmithDM, O'ConnorR, . Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey. BMJ Open.2019;9(3):E024497.
22.
YongH-H, HitchmanSC, CummingsKM, . Does the regulatory environment for e-cigarettes influence the effectiveness of e-cigarettes for smoking cessation?: longitudinal findings from the ITC Four Country Survey. Nicotine Tob Res.2017;19(11):1268–1276.
23.
McNeillA, BroseLS, CalderR, HitchmanSC, HajekP, McRobbieH.E-cigarettes: an evidence update. A report commissioned by Public Health England; London, UK: Public Health England 2015.
24.
HammondD, ReidJL, RynardVL, . Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys. BMJ. 2019;365:l2219.
25.
CohnAM, AbudayyehH, PerrerasL, PetersEN.Patterns and correlates of the co-use of marijuana with any tobacco and individual tobacco products in young adults from Wave 2 of the PATH Study. Addict Behav.2019;92:122–127.
26.
PetersEN, BaeD, Barrington-TrimisJL, JarvisBP, LeventhalAM.Prevalence and Sociodemographic Correlates of Adolescent Use and Polyuse of Combustible, Vaporized, and Edible Cannabis Products. JAMA Netw Open.2018;1(5):e182765.
27.
WadsworthE, HammondD.Differences in patterns of cannabis use among youth: prevalence, perceptions of harm and driving under the influence in the USA where non-medical cannabis markets have been established, proposed and prohibited. Drug Alcohol Rev.2018;37(7):903–911.
28.
WadsworthE, HammondD.International differences in patterns of cannabis use among youth: prevalence, perceptions of harm, and driving under the influence in Canada, England & United States. Addict Behav.2019;90:171–175.
29.
HammondD, ReidJL, WhiteCM, C B. ITC Youth Tobacco And E-Cigarette Survey. Waterloo, ON: University of Waterloo; 2017. Technical Report – Wave 1.
30.
HartleyJE, LevinK, CurrieC.A new version of the HBSC family Affluence Scale - FAS III: Scottish qualitative findings from the international FAS Development Study. Child Ind Res.2016;9(1):233–245.
31.
TorsheimT, the FAS Development Study Group, . Psychometric Validation of the Revised Family Affluence Scale: a latent variable approach. Child Ind Res.2016;9(3):771–784.
32.
JohnstonL, MiechR, O'MalleyP, BachmanJ, SchulenbergJ, PatrickM.2018 Overview: Key Findings on Adolescent Drug Use. Ann Arbor, Michigan: Institute for Social Research, University of Michigan, 2019.
33.
FrankfordER.Changing service systems for high-risk youth using state-level strategies. Am J Public Health.2007;97(4):594–599.
34.
HallW, StjepanovićD, CaulkinsJ, . Public health implications of legalising the production and sale of cannabis for medicinal and recreational use. Lancet.2019;394(10208):1580–1590.
35.
BorodovskyJT, CrosierBS, LeeDC, SargentJD, BudneyAJ.Smoking, vaping, eating: is legalization impacting the way people use cannabis?Int J Drug Policy.2016;36:141–147.
36.
United States Department of Health and Human Services. E-cigarette use Among Youth and Young Adults. Atlanta, GA: USDHHS; 2016. A Report of the Surgeon General.
37.
LaydenJE, GhinaiI, PrayI, . Pulmonary illness related to e-cigarette use in Illinois and Wisconsin — preliminary report. N Engl J Med.2019. doi:10.1056/NEJMoa1911614.
McDonaldEA, PopovaL, LingPM.Traversing the triangulum: the intersection of tobacco, legalised marijuana and electronic vaporisers in Denver. Tob Control.2016;25(1):i96–i102.
40.
PopovaL, McDonaldEA, SidhuS, . Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research. Addiction.2017;112(10):1821–1829.
41.
KnappAA, LeeDC, BorodovskyJT, AutySG, GabrielliJ, BudneyAJ.Emerging trends in cannabis administration among adolescent cannabis users. J Adolesc Health.2019;64(4):487–493.
42.
BoykanR, MessinaCR, ChateauG, EliscuA, TolentinoJ, GoniewiczML.Self-reported use of tobacco, e-cigarettes, and marijuana versus urinary biomarkers. Pediatrics.2019;143(5):e20183531.
