Young adults and other vulnerable populations are more likely to use both tobacco and cannabis these days due to more tobacco ads targeting youth and liberalizing attitudes towards cannabis. Using both of these substances together, also called co-use, is linked to a number of potential negative outcomes, including cannabis dependence, returning to use after quitting, poor academic performance, and increased exposure to toxins. Therefore, there is a need for a more nuanced and shared understanding of co-use behavior, in order to deliver effective interventions and guide research. This week, ASHES reviews a study by Nhung Nguyen and colleagues that explored patterns of use and motivations for the co-use of tobacco and cannabis and young adults.
What was the research question?
What are the motivations for and patterns of tobacco and cannabis co-use among young adults in the U.S.?
What did the researchers do?
The researchers recruited 34 young adults (aged 18-29) in California who had participated in an earlier longitudinal qualitative study and who reported past 30-day use of cannabis. Participants completed an in-depth interview, answering questions about their cannabis and tobacco use related to several topics that included routines of use/co-use and motivations for use/co-use1. The research team then recorded and transcribed each interview and conducted thematic analysis.
What did they find?
Overall, participants reported that they used substances for socialization, due to the availability of both products and to cope with stress. However, four distinct patterns of co-use emerged, with some different motivations.
- Same month, different day users reported motivations like seeking substance-specific effects and socialization.
- Same day, different occasion users were similarly motivated by substance-specific effects though to a greater degree.
- Same occasion, sequential users sought to experience the effects of both substances simultaneously, often chasing one high with the other for a unique experience.
- Same occasion, simultaneous users also sought to experience the effects of both substances simultaneously; they also reported that their co-use was a habit spurred on by behavioral triggers, using many addiction-related terms such as “cravings” (see Figure).
Figure. Motivations for tobacco and marijuana co-use, with a quote representing each. Themes on the left were shared among all four patterns of co-use, while those on the right were only represented by specific groups. For instance, habits/triggers were only a motivator for same occasion, simultaneous use.
Why do these findings matter?
These findings provide insight into patterns of cannabis and tobacco co-use. Additionally, the study was able to identify unique motivations that differ based on patterns of use, which holds promise for improving smoking cessation interventions. For example, smoking cessation programs focused on motivations may benefit from first identifying the specific pattern(s) of use and then tailoring the intervention(s) accordingly.
Every study has limitations. What are the limitations in this study?
Participants were from California, where recreational marijuana has been legal for several years. The perceptions of and experiences with marijuana are likely to differ from people in areas where marijuana is not yet legal or has recently become legal, limiting generalizability. Further, an inclusion criterion for this study was that participants must have reported using multiple tobacco products; it is possible that this criterion might have biased the sample towards heavier users.
For more information:
Individuals who want to reduce their smoking should visit the Truth Initiative. Others who want to learn more about the effects of or quit smoking should visit the CDC’s website. Additional resources can be found at the BASIS Addiction Resources page.
—John Slabczynski
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1. The researchers explored other topics such as changes over time and perceptions of benefits compared to harms though these themes were not well represented in participants’ responses and so we do not cover them in this review.