Reasons for Marijuana and Tobacco Co-use Among Young Adults: A Mixed Methods Scale Development Study

Abstract

Background Marijuana-tobacco co-use has increased recently, particularly in young adults. Objectives We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities. Methods Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section. Results Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other’s use, using one to reduce the other’s use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% smokeless, 23.7% e-cigarettes, and 30.4% hookah. Four subscale factors emerged: (1) Instrumentality, indicating synergistic effects; (2) Displacement, indicating using one product to reduce/quit the other; (3) Social context, indicating use in different settings/social situations; and (4) Experimentation, indicating experimentation with both but no specific reasons for co-use. These subscales demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives, respectively; perceptions of tobacco and marijuana; and parental and friend use. Including these subscales in regressions predicting nicotine dependence and days of marijuana use significantly contributed to each model. Conclusions These findings might inform theoretical frameworks upon which marijuana-tobacco co-use occurs and direct future intervention studies.

Trends of poly-substance use among Canadian youth

“…The association between e-cigarettes and alcohol, previously observed in other studies ( Morean et al, 2016 ; Schlienz & Lee, 2018 ; Taylor et al, 2017 ), together with data on social media trends ( Camenga et al, 2018 ; Chu et al, 2018 ; Sampasa-Kanyinga & Hamilton, 2018 ), indicates that use of the former is now a social activity ( Pepper et al, 2017 ; Yule & Tinson, 2017 ). This is particularly concerning not only in light of potential feedback effects due to the previously discussed outsize effects of peer behaviour, but also because e-cigarette use has been shown to increase the risk of cigarette smoking ( Barnett et al, 2015 ; Bold et al, 2018 ; Hammond et al, 2017 ), which also often co-occurs with alcohol use in social situations ( Berg et al, 2018 ; Gubner, Thrul, Kelly, & Ramo, 2018 ; Silveira et al, 2018 ), adding an additional layer of risk. Concerningly, early initiation of cigarette and alcohol co-use may increase the likelihood of opioid use ( Arterberry et al, 2016 ), and the possibility that vaping may come to replace smoking in this role cannot yet be discounted.…”

Cannabis Use Is Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse Among Adults in the United States

“…In addition, the neurobiological systems involved with nicotine and cannabis (ie, the nicotinic and endocannabinoid systems) overlap. 9,14 Cigarettes and cannabis are used to enhance the effects or relieve withdrawal symptoms of the other 17,18 and prior studies suggest that co-use of both cannabis and cigarettes, versus cigarette use alone, is associated with greater smoking quantity and greater nicotine dependence symptoms 19 which may in turn make it more difficult to quit smoking. Future research is needed to clarify how these different mechanisms relate to smoking initiation, cessation, and relapse and how prevention and intervention efforts might best work with cannabis users to reduce cigarette smoking-related behavior and harm.…”

“…The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study focused on assessing tobacco use and health behavior in a population representative sample of civilian, noninstitutionalized US adults (18 years and older) and youth (12 years and older). The PATH study oversampled adult tobacco users, young adults (ages [18][19][20][21][22][23][24], and non-Hispanic black adults. The PATH study is sponsored by the National Institute on Drug Abuse and the Food and Drug Administration's Center for Tobacco Products with data collected by Westat.…”

Cigarette smoking quit ratios among adults in the USA with cannabis use and cannabis use disorders, 2002–2016

“…). The neurobiological systems involved with nicotine and cannabis overlap29 48 and persons who co-use cigarettes and cannabis have higher nicotinic acetylcholine receptor availability57 so cannabis or cigarettes may be used to enhance the effects of the other drug 58. Further, nicotine may alleviate or decrease negative effects of cannabis (eg, withdrawal,59 cognitive effects60–62).…”