The Mull Hypothesis: is cannabis use contributing to high tobacco use prevalence among young North Coast males?

Lifetime marijuana use and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study

“…We tested sensitivity of the results to alternate modeling techniques: (1) a multivariate adjusted model that included an interaction term between history of exposure to tobacco smoking and cumulative exposure to marijuana; (2) a multivariate adjusted model that compared participants according to history of exposure to marijuana and tobacco, (a) no history of exposure to tobacco or marijuana, (b) history of exposure to tobacco and not to marijuana, (c) no history of exposure to tobacco and history of exposure to marijuana and (d) history of exposure to both tobacco and marijuana; and (3) a set of multivariate regressions that enabled us to model AAC and CAC as continuous measures (eMethods, Supporting information). We further evaluated the proportion of participants who might have been mixing tobacco with marijuana to smoke marijuana (mulling) at baseline by measuring blood cotinine levels, and we then tested the sensitivity of the results to excluding participants with cotinine levels suggestive of tobacco exposure and no self‐reported use of tobacco at baseline (eMethods, Supporting information) . Tests of statistical significance were two‐tailed; alpha level was 0.05.…”

The co‐occurring use and misuse of cannabis and tobacco: a review

“…marijuana cigarettes, or in bongs or pipes) or can be rolled with small amounts of tobacco to facilitate smoking (referred to as mulling in some countries) (20;76;77). Some studies contend that these small amounts of tobacco produce nicotine withdrawal which cannabis users stave off by sustained use of tobacco-containing cannabis preparations (78;79). Preliminary research also indicates that cannabis and tobacco are often smoked on the same occasion and that these simultaneous users are at greater risk for cannabis use disorders (80).…”

Smoking mull: a grounded theory model on the dynamics of combined tobacco and cannabis use among adult men

“…There is growing evidence that cannabis users can become regular users of tobacco through mixing cannabis and tobacco. [11][12][13] Van Beurden et al 14 suggested mull smoking may be slowing tobacco quit rates among 25-34-year-old males in northern New South Wales (NSW), because those who smoke mull find it more difficult to quit tobacco. A systematic review on co-occurring cannabis and tobacco use concluded that mull users have poorer cessation outcomes than those who only use cannabis.…”

“…It aims to understand the process of smoking tobacco and cannabis together among 25-34-year-old males in northern NSW who are current and past users of both substances. This region was selected because tobacco use prevalence in men aged 25-34 years has been higher than the state average for a decade; 14 it is also associated with high cannabis use. 23…”