Co-use of Tobacco/Nicotine and Cannabis Among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes

Abstract

While tobacco and cannabis use rates remain high in the general U.S. population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at particularly high risk of high rates of cannabis and tobacco use. Co-use of tobacco/nicotine and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the United States. Tobacco/nicotine and cannabis use is often associated with poor mental health outcomes such as stress, anxiety, and depression. However, little is understood about the prevalence rates of tobacco/nicotine and cannabis co-use among U.S. veterans as well as associations with mental health symptomology. The current study aimed to investigate types of tobacco/nicotine and cannabis co-use among veterans, as well as associations between co-use and mental health outcomes of stress, depression, anxiety, and posttraumatic stress disorder. Participants (N= 1,548) were recruited through social media websites and completed an online survey as part of a larger study. The majority (80%) endorsed tobacco/nicotine and/or cannabis use in the past 30 days. Descriptive analyses were run to assess prevalence of use within the sample. Mean comparisons were conducted to assess differences in past 30-day frequency of use and for mental health outcomes between co-users and single users of either substance. Among the larger sample, 90% endorsed lifetime use of tobacco/nicotine, 23% endorsed lifetime use of cannabis, and 21% endorsed any lifetime co-use of both substances. These participants also endorsed past 30 day use of tobacco/nicotine (77%), cannabis (10%), and co-use (7%). Among the past 30-day cannabis users, 66% reported also using tobacco/nicotine, while 9% of past 30-day tobacco/nicotine users also reported cannabis use. When comparing cannabis-only users to co-users of cannabis and tobacco/nicotine, anxiety symptoms were reported as significantly higher among co-users. Tobacco/nicotine-only users endorsed higher past 30-day frequency of cigarettes and e-cigarettes compared to co-users; however, co-users endorsed significantly higher levels of stress and symptoms of PTSD, depression, and anxiety compared to tobacco/nicotine-only users. Results suggest that the addition of cannabis use in conjunction with tobacco/nicotine use may be associated with greater mental health symptoms among veterans. Findings have implications for future veteran mental health care and substance use treatment among tobacco/nicotine and cannabis co-users.