Co-use Of Tobacco Research Articles

Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation.

Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly "cold turkey." The priority product for quitting first varied by the individual's perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. This study provides important insights into young adults' experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes.

Characterizing the Cannabis Withdrawal Trajectory in Men With Cannabis and Tobacco Co-Use: A Preliminary Study

ABSTRACT Background: Cannabis and tobacco co-use is prevalent, and individuals who co-use have elevated cannabis relapse rates compared with those using cannabis alone. Research demonstrates that individuals who co-use experience greater cannabis withdrawal severity, a strong predictor of cannabis relapse, compared with those using cannabis alone. In this secondary analysis, we compared the trajectory of cannabis withdrawal severity during 28 days of cannabis abstinence in individuals with cannabis use disorder parsed according to tobacco co-use status. Methods: Men with cannabis use disorder (N=20) were parsed according to tobacco co-use: those with heavy (CT-H ≥10 cigarettes/day, n=11) and light tobacco co-use (CT-L ≤5 cigarettes/day, n=9). Participants completed 28 days of cannabis abstinence encouraged by contingency management and supportive therapy. Cannabis withdrawal severity was assessed weekly using the Marijuana Withdrawal Checklist. Abstinence was biochemically verified using urine analyzed by gas chromatography-mass spectrometry. Results: Fourteen participants achieved 28 days of biochemically verified cannabis abstinence and 4 participants significantly reduced their cannabis use (>70%); 2 participants relapsed and were excluded from the analyses. In the included participants (CT-H, n=9; CT-L, n=9), there was a significant interaction (group x time) effect for Marijuana Withdrawal Checklist severity (P=0.03). Relative to CT-L, CT-H exhibited elevated cannabis withdrawal severity across multiple time points during cannabis abstinence. Conclusions: CT-H experiences elevated cannabis withdrawal severity that persists throughout 28 days of cannabis abstinence, relative to CT-L. Since withdrawal symptoms that remain elevated in severity over time prolong cannabis relapse risk, personalized approaches that target heavy tobacco co-use in CT-H may improve rates of cannabis cessation. Contexte: La consommation simultanée de cannabis et de tabac est répandue, et les personnes qui la pratiquent ont des taux de rechute élevés pour le cannabis par rapport à celles qui consomment seulement du cannabis. Les recherches démontrent que les personnes qui font un usage conjoint éprouvent une plus grande intensité de sevrage du cannabis, un facteur prédictif important de rechute, par rapport à celles qui ne consomment que du cannabis. Dans cette analyse complémentaire, nous avons comparé la courbe d’intensité du sevrage du cannabis pendant 28 jours d’abstinence chez des personnes souffrant de troubles liés à l’usage du cannabis et classées en fonction de leur statut de consommateur simultané de tabac. Méthodes: Les hommes souffrant de troubles liés à la consommation de cannabis (N=20) ont été répartis en fonction de leur consommation simultanée de tabac : ceux ayant une forte consommation de tabac (CT-H ≥10 cigarettes/jour, n=11) et ceux ayant une faible consommation de tabac (CT-L ≤5 cigarettes/jour, n=9). Les participants ont suivi 28 jours d’abstinence de cannabis, encouragés par une gestion des contingences et une thérapie de soutien. La sévérité du sevrage du cannabis a été évaluée chaque semaine à l’aide de la liste de contrôle du sevrage de la marijuana (Marijuana Withdrawal Checklist-MWC). L’abstinence a été vérifiée biochimiquement en analysant l’urine par chromatographie en phase gazeuse et spectrométrie de masse. Résultats: Quatorze participants ont atteint 28 jours d’abstinence de cannabis vérifiée biochimiquement et quatre participants ont réduit de manière significative leur consommation de cannabis (>70%); deux participants ont rechuté et ont été exclus des analyses. Parmi les participants inclus (CT-H, n=9; CT-L, n=9), il y avait un effet d’interaction significatif (groupe x temps) pour la sévérité de la MWC (P=0,03). Par rapport à CT-L, CT-H a présenté une sévérité de sevrage du cannabis élevée sur plusieurs points temporels pendant l’abstinence de cannabis. Conclusions: Les CT-H présentent une sévérité de sevrage du cannabis élevée qui persiste pendant les 28 jours d’abstinence, par rapport aux CT-L. Étant donné que les symptômes de sevrage dont la gravité reste élevée au fil du temps prolongent le risque de rechute de consommation de cannabis, les approches personnalisées qui ciblent la forte consommation conjointe avec le tabac chez les CT-H peuvent améliorer les taux d’abandon du cannabis.

Bidirectional relationships between pain and patterns of cannabis and tobacco use in a US nationally representative sample.

One-fifth of US adults experience chronic pain, which is associated with increased tobacco and cannabis use. Although bidirectional relationships between tobacco and pain have been demonstrated, pathways between pain, cannabis use, and co-use of cannabis and tobacco are understudied. We aimed to estimate the effects of (1) substance use (exclusive and co-use of cannabis and tobacco) on later pain intensity, and (2) pain intensity on later substance use. Data were from 31,983 adults in biennial surveys (2015-2021) of the US nationally representative longitudinal Population Assessment of Tobacco and Health Study (n = 71,055 pairs of consecutive surveys; T1 and T2). Past-week pain intensity was dichotomized (≤4/10 no/low pain; >4/10 moderate/severe pain). Mutually exclusive substance use categories (past 30 days) were no cannabis/tobacco use; exclusive cannabis/tobacco use; and co-use. Logistic regression assessed whether T1 substance use affected moderate/severe pain at T2. Multinomial models assessed whether pain status at T1 affected substance use at T2. Compared with no cannabis/tobacco use at T1, co-use (OR: 2.29 [95% CI: 2.09-2.51]), exclusive tobacco use (2.00 [1.86-2.14]), and exclusive cannabis use (1.35 [1.13-1.61]) were all associated with moderate/severe pain at T2. Moderate/severe pain at T1 increased odds of co-use (2.43 [2.22-2.66]), exclusive tobacco (2.12 [1.98-2.28]), and exclusive cannabis use (1.46 [1.29-1.65]) compared with no cannabis/tobacco use at T2, and increased odds of co-use at T2 compared with exclusive cannabis/tobacco use. Findings demonstrated bidirectional relationships between pain and the exclusive use and co-use of cannabis and tobacco and indicate potential synergy in the co-use of cannabis and tobacco with respect to pain.

Prenatal Cannabis and Tobacco Co-Exposure and Its Association with Behavioural Outcomes in Middle Childhood: Co-exposition prénatale au cannabis et au tabac et son association avec les résultats comportementaux au cours de l'enfance intermédiaire.

Cannabis legalization has triggered an increase in prenatal cannabis use. Given that tobacco is commonly co-used with cannabis, determining outcomes associated with prenatal cannabis and tobacco co-exposure is crucial. While literature exists regarding the individual effects of prenatal cannabis and tobacco exposure on childhood behaviour, there is a gap regarding their combined use, which may have interactive effects. Therefore, we investigated whether prenatal cannabis and tobacco co-exposure was associated with greater externalizing and internalizing problems in middle childhood compared to prenatal exposure to either substance alone or no exposure. Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9-11) were used to explore differences in externalizing and internalizing scores derived from the Childhood Behavior Checklist across four groups: children with prenatal cannabis and tobacco co-exposure (CT, n = 290), children with prenatal cannabis-only exposure (CAN, n = 225), children with prenatal tobacco-only exposure (TOB, n = 966), and unexposed children (CTL, n = 8,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes. Adjusting for covariates, a 2 × 2 ANCOVA revealed significant main effects for prenatal cannabis (p = 0.03) and tobacco exposure (p < 0.001), and a significant interaction effect on externalizing scores (p = 0.032); no significant main effects or interactions were found for internalizing scores. However, interactions between daily quantity of cannabis and tobacco exposure significantly predicted both externalizing and internalizing scores (p < 0.01). These findings indicate that co-exposure is associated with greater externalizing problems than exposure to either substance alone, which did not differ from each other. Further, greater tobacco exposure may amplify the negative effect of cannabis exposure on both externalizing and internalizing behaviours in children. These findings underscore the need for interventions that target cannabis and tobacco co-use in pregnant women to circumvent their adverse impact on middle childhood behaviour.

Trends in cannabis and tobacco co-use in the United States, 2002–2021

BackgroundCo-use of cannabis and tobacco poses greater risks than use of either substance individually and may be becoming more prevalent with increasing cannabis medicalization and legalization. We aimed to assess trends in the prevalence of cannabis and tobacco co-use between 2002–2019 and identify the updated prevalence and correlates of co-use in 2021 among US adults. MethodsThis study used data from the 2002–2021 National Survey on Drug Use and Health, a nationally-representative, cross-sectional survey in the US. We assessed prevalence trends in past 30-day cannabis and tobacco co-use, exclusive cannabis use, and exclusive tobacco use overall and by sociodemographic group using joinpoint regression. Additionally, multinomial models identified correlates of co-use in 2021. ResultsIn 2021, the weighted prevalence of cannabis and tobacco co-use was 6.38 %, the weighted prevalence of exclusive cannabis use was 7.28 %, and the weighted prevalence of exclusive tobacco use was 15.01 %. From 2002 to 2019, the prevalence of past 30-day co-use of cannabis and tobacco increased significantly (annual percentage change [APC]: 1.9 [1.4–2.4], P<0.05) among the overall US population. All subgroups of sex, race/ethnicity, and age also saw significant increases in co-use, other than young adults ages 18–25, for whom co-use was stagnant between 2002–2014 and then decreased significantly between 2014–2019. ConclusionThis study identified increasing cannabis and tobacco co-use overall and among most sociodemographic strata in the US. As cannabis policy changes rapidly, co-use requires closer surveillance, clinical screening, and dedicated research.

Urgent need for treatment addressing co-use of tobacco and cannabis: An updated review and considerations for future interventions

BackgroundThere are no clinical practice guidelines addressing the treatment of tobacco-cannabis co-use and a dearth of studies to inform treatment for co-use. This narrative review aims to (1) summarize promising intervention components used in published co-use treatment studies, (2) describe key gaps and emerging issues in co-use, and (3) provide recommendations and considerations in the development and evaluation of co-use interventions. MethodsWe conducted a literature search in June 2024 across several databases to update previous reviews on tobacco-cannabis co-use treatment. We found 9 published intervention studies that specifically addressed treatment for both substances. Data from these studies were manually extracted and summarized. ResultsMost of the 9 included studies (1) focused on acceptability and/or feasibility, (2) provided both psychosocial/behavioral and pharmacotherapy intervention components, (3) were conducted in adults, and (4) were delivered in-person, with some having digital asynchronous components, for a 5-to-12-week duration. The most common psychosocial/behavioral strategies used were Cognitive Behavioral Therapy, Motivational Interviewing, and Contingency Management; while the most common pharmacotherapy was Nicotine Replacement Therapy. There was no evidence of compensatory use of tobacco or cannabis when providing simultaneous treatment for both substances. ConclusionsThe literature to date provides support for well-integrated multi-component interventions of psychosocial/behavioral and pharmacotherapy strategies for co-use treatment. This review reinforces an urgent need for treatments targeting tobacco and cannabis co-use. Future interventions should address key gaps, including co-use of vaporized products among youth and young adults, tailored interventions for priority populations, and digital applications to increase reach and advance health equity.

Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis

BackgroundCo-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30 days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used. MethodsData were from a cross-sectional national survey (N = 6,131, 13–40 years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13–20; 21–24; 25–40). Results38.4% of participants reported use of both tobacco and cannabis in the past 30 days. Among these participants, 70.9% used tobacco first in their lifetime (66.6% < 21; 71.7% 21–24; 76.6% > 24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3% < 21; 66.7% 21–24; 49.6% > 24). ConclusionsThe majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.

Messages About Tobacco and Alcohol Co-users.

People who use both alcohol and combustible tobacco have an increased risk of developing cancer. Few interventions have been developed to inform people about the risks of co-use. This study developed and tested messages about the risks of alcohol and combustible tobacco co-use among adults. In June-July 2021, we surveyed 1,300 U.S. adults who used both alcohol and combustible tobacco products within the past 30 days. After reporting their awareness of diseases caused by tobacco and alcohol co-use, participants were randomly assigned to four between-subjects experiments that manipulated specific cancer health effects vs. the word "cancer"; cancer health effects vs. noncancer health effects; different descriptions of co-use (e.g., Using alcohol and tobacco…, Drinking alcohol and smoking tobacco…); and co-use vs. single-use messages. Participants saw one message for each experiment and rated each message using a validated perceived message effectiveness (PME) scale. Awareness of health effects caused by alcohol and tobacco co-use ranged from moderately high for throat cancer (65.4%) to moderately low for colorectal cancer (23.1%). Messages about cancer health effects increased PME more than messages about non-cancer health effects (B=0.18, p=0.01). Messages about some specific cancers-including oral cancer (B=-0.20, p=0.04) and colorectal cancer (B=-0.22, p=0.02) decreased PME more than messages with only the word "cancer." No significant differences were identified for descriptions of co-use or co-use vs. single-use messages. Messages about some cancer health effects of co-using alcohol and tobacco may be effective when communicating the harms of both drinking alcohol and using tobacco.

S136 - Trends in Past-Month Alcohol and Tobacco Co-Use Among Older Adults in the US Between 2002-2019

S136 - Trends in Past-Month Alcohol and Tobacco Co-Use Among Older Adults in the US Between 2002-2019

Cannabis policy liberalization is only associated with increased blunt use if states lack strong tobacco control

IntroductionCo-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use—cannabis inside a cigar wrapper—has been a consistent mode of cannabis consumption since the 1990s. Since then, both tobacco control and cannabis policies have changed considerably. This paper examines the influence of tobacco taxes and smoke-free policies as well as medical and recreational cannabis policies on blunt use among young people. MethodsCombining state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use. ResultsWhile we found a main effect whereby both legal medical and recreational cannabis policies are associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoke-free policy. In states with smoke-free policies, we found no significant associations between cannabis policy and odds of blunt use. ConclusionsDenormalization through smoke-free policies may mitigate the effects of recreational and medical cannabis policies on blunt use. Smoke-free policies represent a possible cost-effective mechanism to curb the co-use of tobacco and cannabis in the form of blunts. States with medical and recreational cannabis policies may benefit from greater prevention efforts for young people specifically focused on blunt use, especially in states that do not have strong tobacco control.

Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use

BackgroundFew studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis. MethodCross-sectional online survey of a national convenience sample of 13–40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13–17-, 18–24-, and 25–40-year-olds. ResultsAmong 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06–1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28–2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35–1.80; <0.001), cigarettes (aOR = 1.24, 1.04–1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51–2.42; <0.001), and blunts (aOR = 1.22, 1.00–1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %). ConclusionsScreening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study.

Co-use of tobacco and cannabis may be prevalent in pregnancy, potentially leading to additional adverse health outcomes. Utilizing a national sample of women followed prospectively before, during, and after pregnancy, this study tested whether prepregnancy co-use of tobacco and cannabis (vs. tobacco-only use and cannabis-only use) was associated with greater likelihood of continuing to use tobacco and/or cannabis during pregnancy and postpartum. Data were drawn from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Prepregnancy, pregnancy, and postpartum data were captured and stacked over three intervals (Waves 1-3, 2-4, and 3-5). Participants were N = 686 U.S. women (72% White, 46% age 25-34) who were currently pregnant during the middle wave of an interval. Rates of tobacco-only use, cannabis-only use, and tobacco and cannabis co-use at all three time points were examined. Generalized estimating equation models demonstrated that pregnant women who reported prepregnancy tobacco and cannabis co-use (vs. tobacco-only or cannabis-only use) were more likely to continue to use tobacco and/or cannabis during pregnancy and relapse in postpartum (p < .05). Among women who endorsed prepregnancy co-use and continued to use tobacco and/or cannabis in pregnancy, about half transitioned to tobacco-only use (45.16%). Findings underscore the need for further clinical and empirical focus on dynamic patterns of use/co-use of tobacco and cannabis across the perinatal period, including cessation interventions to reduce tobacco and cannabis use in pregnancy and protect against relapse in postpartum. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Use and Co-Use of Tobacco and Cannabis Before, During, and After Pregnancy: A Longitudinal Analysis of Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study

Supplemental Material for Use and Co-Use of Tobacco and Cannabis Before, During, and After Pregnancy: A Longitudinal Analysis of Waves 1–5 of the Population Assessment of Tobacco and Health (PATH) Study

Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students

To examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students. We analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n=287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools. Current co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (β=-0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR1.19, 95% CI 1.10-1.29) and lower grades (β=-0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis. California youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.

Tobacco and alcohol co-use: Lifestyle and sociodemographic factors, and personality aspects as potential predictors in the "Seguimiento Universidad de Navarra"cohort.

Tobacco and alcohol co-use are two major lifestyle modifiable risk factors. Understanding the determinants of both behaviors helps to develop interventions to prevent these exposures. However, previous studies have focused on predictors of individual tobacco or alcohol use. This study aims to explore the potential predictors of tobacco and alcohol co-use among Spanish university graduates from the "Seguimiento Universidad de Navarra" (SUN) cohort study. A total of 7175 participants who were co-users of tobacco and alcohol were selected for this cross-sectional analysis. Their mean age was 39.1 years (12.04SD) and 57.3% were women. Univariate regression models were used to select the potential predictors of tobacco and alcohol co-use, and the areas under the ROC curves (AUC) were calculated. Multivariable logistic regression models were used to create a predictive model. Baseline potential predictors included sociodemographic factors, lifestyle habits, and perceived personality aspects. In the multivariable model, the main significant potential predictors of tobacco and alcohol co-use were driving under the influence of alcohol (odds ratio [OR] = 1.65 [1.43-1.90]), drinking 1-2 cups of coffee daily (OR = 1.50 [1.24-1.84]), drinking three or more cups of coffee daily (OR = 1.61 [1.35-1.91]), and doing more physical activity than recommended (OR = 1.18 [1.02-1.34]) when compared with the reference group. Conversely, those who were married (OR = 0.87 [0.75-0.99], ate at home 7 days a week (OR = 0.69 [0.60-0.80]), or had a high perceived level of competitiveness (OR = 0.83 [0.72-0.95]) had a lower risk of co-use (AUC 0.61 [confidence interval95% 0.59-0.63]), compared to the reference group. These results could be used by healthcare professionals, especially nurses, to effectively assess patients at higher risk of tobacco and alcohol co-use. [Correction added on 16 February 2024, after first online publication: The abstract section has been revised to provide more clarity in this version.].

Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021.

Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).

Increased risk for alcohol- and other substance-exposed pregnancies among women who smoke tobacco: A secondary analysis of a primary care-based intervention.

Among women at risk for alcohol-exposed pregnancies (AEP), smoking tobacco may be associated with increased severity of alcohol use, and risk for tobacco-exposed and other substance-exposed pregnancies (TEPs/SEPs). Our secondary data analysis of the 'CHOICES Plus' intervention trial explored AEP and SEP risk by smoking status. Eligible women (N=261) were recruited from 12 primary care clinics in a public healthcare system, not pregnant, aged 18-44 years, drinking >3 drinks/day or >7 drinks/week, sexually active, and not using effective contraception. We compared women who did and did not smoke tobacco on alcohol and drug severity, and psychological distress (e.g. anxiety) at baseline. Participants were primarily Hispanic (47.1%) or non-Hispanic Black (41.8%) and reported incomes <$20000/year (69.3%). Tobacco smoking prevalence was 45.2%. Compared to non-smokers, those who smoked drank more days/week (mean=3.3, SD=2.0 vs mean=2.7, SD=1.8, p<0.01), had higher alcohol use disorders identification test (AUDIT) scores (mean=12.1, SD=7.6 vs mean=9.8, SD=7.1, p<0.05), were more likely to report current drug use (66.1% vs 48.3%, p<0.01), and had a greater number of (lifetime) drugs used (mean=3.0, SD=2.0 vs mean=2.0, SD=1.5 days, p<0.0001). Also, those who smoked reported greater levels of anxiety (mean=5.9, SD=5.6 vs mean=4.5, SD=4.9, p<0.05), lower confidence to not drink (mean=2.8, SD=0.8 vs mean=3.1, SD=1.0, p<0.01), lower confidence to reduce risky drinking (mean=6.3, SD=3.1 vs mean=7.3, SD=2.8, p<0.0001), greater drinking temptations (mean=3.0, SD=0.9 vs mean=2.6, SD=0.9, p<0.01), and, yet greater readiness to reduce alcohol use (mean=6.2, SD=3.0 vs mean=5.2, SD=3.0, p<0.05). Women who drink and smoke may have the highest AEP, TEP, and other SEP risk. Primary care providers should screen for alcohol and tobacco co-use and provide brief intervention and/or treatment referral. The study was registered on the official website of ClinicalTrials.gov. ID NCT01032772.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies

ABSTRACT Background: People with schizophrenia have high rates of cannabis use disorder (CUD) as well as co-use of tobacco. Tobacco may be used to alleviate cannabis cravings. Objectives: We conducted a secondary analysis of 7 and 28 days of cannabis abstinence from two datasets of participants with CUD with and without schizophrenia to assess cannabis craving, cannabis use in grams per day (GPD) and cigarettes per day (CPD). Methods: We recruited 49 participants (schizophrenia n = 29; control n = 20; 2% female) with CUD. All participants received weekly behavioral support sessions to assist with cannabis abstinence/reduction. GPD and CPD were assessed with the 7-day Timeline Follow-back; the Marijuana Craving Questionnaire (MCQ) assessed compulsivity, emotionality, expectancy and purposefulness subscales. Effects of GPD and MCQ subscales on CPD at days 7 and 28 were assessed with analysis of covariance. Results: At day seven, participants with schizophrenia scored higher on compulsivity (t = 2.72, df = 46.8, p < .01), emotionality (t = 2.48, df = 45.2, p = .02), and purposefulness (t = 2.32, df = 39.41, p = .02) craving subscales than control participants. There was a significant interaction between high purposefulness craving and low GPD on high CPD at day seven (F1,23 = 4.76, p = .039) and day 28 (F1,13 = 7.02 p = .02) in schizophrenia participants but not control participants. Conclusion: We found preliminary evidence that due to cannabis craving intensity, people with schizophrenia and CUD may use more cigarettes when reducing cannabis use, as compared to CUD participants without schizophrenia. Strategies to manage cannabis craving and avoid increasing tobacco use will be useful to implement in intervention strategies. Clinical Trial Name Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in Schizophrenia URL: www.clinicaltrials.gov; Registration Number: NCT03189810;

Comparing Cannabis Use for Pain to Use for Other Reasons in Primary Care Patients.

Medical cannabis is commonly used for chronic pain, but little is known about differences in characteristics, cannabis use patterns, and perceived helpfulness among primary care patients who use cannabis for pain versus nonpain reasons. Among 1688 patients who completed a 2019 cannabis survey administered in a health system in Washington state, where recreational use is legal, participants who used cannabis for pain (n = 375) were compared with those who used cannabis for other reasons (n = 558) using survey and electronic health record data. We described group differences in participant characteristics, use patterns, and perceptions and applied adjusted multinomial logistic and modified Poisson regression. Participants who used cannabis for pain were significantly more likely to report using applied (50.7% vs 10.6%) and beverage cannabis products (19.2% vs 11.6%), more frequent use (47.1% vs 33.1% for use ≥2 times per day; 81.6% vs 69.7% for use 4 to 7 days per week), and smoking tobacco cigarettes (19.2% vs 12.2%) than those who used cannabis for other reasons. They were also significantly more likely to perceive cannabis as very/extremely helpful (80.5% vs 72.7%), and significantly less likely to use cannabis for nonmedical reasons (4.8% vs 58.8%) or report cannabis use disorder symptoms (51.7% vs 61.1%). Primary care patients who use cannabis for pain use it more frequently, often in applied and ingested forms, and have more co-use of tobacco, which may differentially impact safety and effectiveness. These findings suggest the need for different approaches to counseling in clinical care.

Longitudinal patterns of cannabis and tobacco co-administration and concurrent use among young adult college students

IntroductionCo-use, including concurrent use or co-administration, of cannabis and tobacco is most prevalent in young adulthood and associated with worse health outcomes than use of either substance alone. This study examined latent classes of tobacco and cannabis concurrent use and co-administration, and transitions between classes from 2016 to 2019, among a sample of young adult college students in Texas. MethodsParticipants included 4,448 young adults (64.2% female, 64.7% non-white, mean age = 20.5) in a longitudinal cohort study. Measures included past 30-day use of cigarettes. hookah, cigars, ENDS, cannabis, and cannabis and tobacco co-administration. Latent Markov models were used to estimate latent class membership and transitions between classes from 2016 to 2017 and 2017 to 2019. ResultsFour latent classes emerged: non-use (58% of students) characterized by low/no probability of any use; general use (19%) characterized by some level of use of all behaviors; blunt and cannabis use class (13%) characterized by high probabilities of cannabis use and co-administration with blunts; and concurrent and co-administration use (10%) with high probabilities of cigarette, cannabis, blunt, and spliff use. Most students remained in the same latent class from 2016 to 2019. ConclusionsWhile most students reported low/no tobacco and cannabis co-use, those who used cannabis and/or tobacco remained in their use classes over the course of the study (2016 to 2019). Public health advocates on college campuses should consider prevention and cessation programs that incorporate the constellation of behaviors related to cannabis and tobacco co-use and educate students about the health consequences of co-use.