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Objectives. To examine trends in young adult self-reported driving under the influence of alcohol (DUI-A), cannabis (DUI-C), and simultaneous alcohol and cannabis use (DUI-AC) in a state with legalized nonmedical cannabis use from before to during the COVID-19 pandemic. Methods. We used logistic regression and annual statewide data from the Washington Young Adult Health Survey to assess DUI behaviors from 2016 to 2021. Results. Both prepandemic yearly changes in prevalence and deviations from those trends during the pandemic years were small and not statistically significant. However, prevalence estimates were alarming: 12.0% of participants reported DUI-A, 12.5% reported DUI-C, and 2.7% reported DUI-AC. Exploratory moderation analyses indicated a relative increase in DUI-A during 2020 among 4-year college students relative to young adults not attending 4-year colleges. Conclusions. Young adults in Washington State continued to engage in risky DUI behaviors during the pandemic. College students may have increased their likelihood of DUI-A during COVID-19. Public Health Implications. Young adults, for whom vehicle crashes remain a leading cause of death, showed little change in DUI behaviors during the COVID-19 pandemic. There is continued need for young adult DUI prevention efforts. ( Am J Public Health . 2024;114(S8):S698-S701. https://doi.org/10.2105/AJPH.2024.307767).

Over the past two decades, vaping has increased in popularity among young adults. Yet, little is known about the daily activities or contexts associated with vaping behavior. The current study examined whether nicotine vaping, cannabis vaping, and dual-substance vaping (i.e., vaping both nicotine and cannabis) fluctuated in tandem with alcohol use and activities on a given day. Data came from the Monitoring the Future Vaping Supplement, a national sample of U.S. young adults. A subsample of people who vaped (N = 330 people) completed up to 14 daily surveys (N = 3686 days). Multilevel logistic regressions separated within- and between-person characteristics and controlled for combustible nicotine and cannabis use, day of the week, and demographic characteristics. Weights accounted for the complex survey design and attrition. Results demonstrated that nicotine vaping was more common on days when participants drank moderately or binge drank (compared to not drinking), used cigarettes, and spent more time at bars and parties than usual. Cannabis vaping on a given day was more likely on days when young adults drank moderately and spent more time at bars/parties. Likewise, moderate drinking, spending more time at bars/parties than usual, and spending less time on schoolwork than usual was associated with a higher likelihood of dual-substance vaping on a given day. Our findings highlight when young adults vape nicotine and cannabis, while also identifying proximal correlates of these behaviors to inform intervention and cessation efforts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Co-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., Methods: This 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., Results: In 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., Conclusion: This 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Prospective associations of adolescent cannabis use with nicotine use persistence are not well characterized but are important for informing prevention and policy. This study examined the association of 4 types of cannabis product use with subsequent persistent nicotine product use among adolescents., Methods: We used prospective data from an adolescent cohort (14-17 years) from Southern California surveyed at baseline and at approximately 6-month follow-up (2022-2023). We incorporated three mutually non-exclusive analytic samples comprised of individuals with baseline past 6-month use of: (1) any nicotine product (N=308 [mean[SD] age = 16.3[0.6] years]), (2) e-cigarettes (n = 276), and (3) any combustible tobacco product (n = 137). Baseline past 6-month cannabis smoking, vaping, edible use, cannabidiol [CBD] or hemp product use, and any cannabis product use (yes/no) were separately modeled as predictors of past 6-month persistent use of any nicotine products, e-cigarettes, and combustible tobacco at follow-up., Results: Baseline use of any cannabis product was associated with increased odds of persistent use of e-cigarettes or any nicotine product (adjusted odds ratio[OR] range: 1.96-2.66). Cannabis smoking was positively associated with persistent any nicotine product use (adjusted OR=2.19, 95 % CI=1.20-4.02). Cannabis smoking, vaping, and edible use predicted persistent use of e-cigarettes (adjusted OR range: 2.22-2.79). Cannabis product use did not predict combustible tobacco use persistence. Associations of CBD/hemp product use with nicotine use persistence outcomes were all non-significant., Conclusions: Adolescents who use cannabis may be at elevated risk for persistent nicotine use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Sexual and gender minority individuals are more likely to use tobacco and cannabis and have lower cigarette cessation. This study examined cannabis use associations with daily cigarettes smoked in sexual and gender minority individuals before and during a quit attempt., Method: Participants included dual smoking same-sex/gender couples from California that were willing to make a quit attempt (individual n = 205, 68.3% female sex). Participants reported baseline past 30-day cannabis use and number of cigarettes smoked and cannabis use (yes/no) during 35 nightly surveys. Individuals with current cannabis use reported baseline cannabis use and/or nightly survey cannabis use. Multilevel linear models predicted number of cigarettes smoked by cannabis use., Results: Number of cigarettes decreased from before to during a quit attempt, but this decrease was smaller in individuals with current cannabis use compared to no current cannabis use ( p < .001). In individuals with current cannabis use, number of cigarettes smoked was greater on days with cannabis use ( p < .001). Furthermore, cannabis use that day increased overall number of cigarettes in those with relatively high overall cannabis use but only during a quit attempt in those with relatively low cannabis use (Within-Subject Cannabis Use × Between-Subject Cannabis Use × Quit Attempt interaction; p < .001)., Conclusions: Sexual and gender minority individuals with cannabis and cigarette use may have a harder time quitting smoking than those who do not use cannabis. For those with cannabis use, guidance on not using cannabis during a quit attempt may improve cigarette cessation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: There are few studies on harms attributed to others' cannabis use. We assessed individual- and contextual-level correlates of secondhand harms from cannabis use and considered whether cannabis legalization support, along with cannabis user status, predicted such harms., Method: Data were from five repeated cross-sectional, state-representative telephone surveys of Washington State residents ages 18 and older, years 2014-2016. For four surveys, outcome variables were past-12-month reports of experiencing any of five harms (family, traffic-related, vandalism, physical, or financial), and in 2016 only, three harm types separately: (a) harassment, (b) safety-related (traffic, vandalism, physical), and (c) family or financial, attributed to another's cannabis use. All models included a three-category typology comprising participants' own cannabis use and whether they supported cannabis use legalization (user supporter, nonuser nonsupporter, nonuser supporter). We estimated logistic regression models for the full sample and by gender, adjusting for individual- and Census tract-level covariates., Results: Compared with non-cannabis users supporting legalization, nonusers who did not support legalization reported significantly greater odds of perceiving secondhand cannabis harms. Cannabis users supporting legalization did not differ from nonuser supporters. Predictors of reported harms also differed by gender. Whereas current drinkers had lower odds of reporting any harm from others' cannabis use overall, heavy-drinking women but not men reported greater odds of any cannabis secondhand harm., Conclusions: Augmenting research on individual harms associated with cannabis use by including secondhand impacts such as social and family problems, along with safety risks, provides a more comprehensive picture of the effects of cannabis use.

[Correction Notice: An Erratum for this article was reported in Vol 38(7) of Psychology of Addictive Behaviors (see record 2025-40494-001). In Table 1, the Past 30-day cannabis use row now appears as Past 30-day cannabis only use; the Past 30-day tobacco use row now appears as Any past 30-day tobacco use. The Total sample at prepregnancy sample of 344 (50.14%) now appears as 342 (49.85%). Figure 3 also has been updated. All versions of this article have been corrected.] Objective: 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., Method: 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., Results: 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%)., Conclusions: 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).

Background: Co-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., Methods: Data 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)., Results: 38.4% 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)., Conclusions: The 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., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Halpern-Felsher is the Founder and Executive Director of the Stanford Tobacco Prevention Toolkit. She is also a paid expert scientist in some litigation against the e-cigarette industry and an unpaid scientific advisor and expert regarding some tobacco-related policies. The authors have no other conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Early pubertal timing is a risk factor for substance use during adolescence. Fewer studies investigated whether early pubertal timing continues to predict substance use in late adolescence and adulthood, suggesting that long-term effects of pubertal timing vary across substances and by biological sex. Finally, existing studies on pubertal timing and substance use in adulthood involved predominantly White samples. Thus, this longitudinal study examined the concurrent and long-term effects of pubertal timing on alcohol, cigarette, and cannabis use together with sex differences in predominantly Black youth from the United States., Method: The sample included 603 youth (52% male, 80% Black) who were interviewed in early adolescence (mean age: 13.2), late adolescence (mean age: 17.6), and young adulthood (mean age: 27.7). During early adolescence, youth self-reported their physical maturation based on Tanner scores, which were adjusted for age and used as indicators of pubertal timing. Youth self-reported their substance use at each time point., Results: Early pubertal timing was associated with higher odds of alcohol use during early adolescence but did not predict alcohol use during late adolescence or adulthood. While early pubertal timing did not predict cigarette use at any time point, early pubertal timing predicted greater odds for cannabis use during early adolescence and higher rates of cannabis use in adulthood. Moreover, early pubertal timing predicted greater risk for couse of alcohol, cigarettes, and cannabis in adulthood. No effects differed by sex., Conclusions: These findings suggest that links between pubertal timing and substance use vary across substances and developmental periods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Rationale: Cannabis use is rapidly growing in the United States, but its health implications are poorly understood, particularly when compared with cigarette smoking. Previous research conducted on animal models or nonrepresentative populations with small sample sizes has yielded mixed results on the impact of marijuana use on hemoglobin concentrations, which might reflect subclinical hypoxemia and/or carbon monoxide exposure. Objectives: We evaluated the association between marijuana use and hemoglobin concentrations in a nationally representative sample of U.S. adults. Methods: This cross-sectional study included 16,038 individuals 18-59 years of age enrolled in National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. We related current and former marijuana use with measured hemoglobin concentrations, with adjustment for demographics, education, housing, and cigarette smoking status in multivariable analyses that incorporated complex survey weights. As candidate positive and negative control exposures, we used similar methods to relate cigarette smoking and benzodiazepine use, respectively, with hemoglobin concentrations. Results: Current marijuana use was associated with significantly higher hemoglobin concentrations. After multivariable adjustment, compared with never use, current marijuana use was associated with a 0.111 (95% confidence interval, 0.021 to 0.201) g/dl higher hemoglobin concentration, whereas former use was associated with a 0.047 (95% confidence interval, -0.018 to 0.113) g/dl higher concentration (linear trend P  = 0.01). As hypothesized, cigarette smoking was also associated with higher hemoglobin concentrations, whereas benzodiazepine use was not. Conclusions: Among American adults, current marijuana use was associated with higher hemoglobin concentrations, as is cigarette smoking but not benzodiazepine use. These results suggest the possibility that marijuana smoking induces subclinical hypoxemia stimulating hemoglobin production. Further confirmation of this observational finding is needed in light of the increasing medical and recreational use of smoked marijuana products.

Introduction: Cannabis is the third most commonly used substance by students. The aim of this study is to describe cannabis use among medical students and understand their motivations. It seeks to establish the link between cannabis and higher education, especially in medicine., Materials and Methods: 202 students from the UMons and ULB universities (Belgium) took part in the study. They completed an anonymous online questionnaire. Their answers were cleaned before analysis., Results: 52% of the students declared they had never used cannabis. The time of first use was most often secondary school. Evenings out with friends and improvement falling asleep were the two most common reasons for using cannabis. The participants attributed little benefit to cannabis use in terms of managing their studies. Medical studies may have an impact on cannabis use., Conclusion: The prevalence of cannabis use appears to be higher among medical students than in the general population, yet few measures are in place to raise their awareness. This study aims to open up the debate on cannabis use among students, especially in the medical school.

Objectives: Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures?, Design: Retrospective., Setting: Single academic level 1 trauma center in Southern California., Patient Selection Criteria: Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow-up., Outcome Measures and Comparisons: Risk factors associated with the development of SSI were compared between current inhalational marijuana users and nonmarijuana users., Results: Complete data were available on 4802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery, 24% (1133 patients) were current users of marijuana. At the final follow-up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection-free group was 46.1 ± 23.1 years, and the average age of the SSI group was 47.0 ± 20.3 (P = 0.73) years. In total, 2703 patients (57%) in the infection-free group were male compared with 48 (64%) in the SSI group (P = 0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI, 1.001-1.004]), diabetic status (OR 2.084 [95% CI, 1.225-3.547]), and current tobacco use (OR 2.493 [95% CI, 1.514-4.106]) (P < 0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI, 0.228-2.013], P = 0.48)., Conclusions: Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The author declares no conflict of interest.

Background: Cannabis is a widely used illicit drug with effects on different pain pathways. However, interactions between cannabis and postoperative pain are unclear. Cannabis smoking also affects the lungs, but the impact of cannabis use on postoperative pulmonary complications is unknown. We hypothesized that preoperative cannabis use in adults having elective surgery is associated with higher postoperative opioid consumption. Secondarily, we tested the hypothesis that cannabis use is associated with higher pain scores, hypoxemia (oxygen saturation [Sp o2 ]/fraction of inspired oxygen [F io2 ] ratio), and higher postoperative pulmonary complications compared to nonuse of cannabis., Methods: In this retrospective study, we included adult patients who had elective surgeries at Cleveland Clinic Main Campus between January 2010 and December 2020. The exposure was use of cannabis within 30 days before surgery, and the control group never used cannabis. Patients who had regional anesthesia or chronic pain diagnosis were excluded. The primary outcome was postoperative opioid consumption; 3 secondary outcomes were time-weighted average (TWA) postoperative pain score, TWA Sp o2 /F io2 ratio, and composite of pulmonary complications after surgery. We assessed the association between cannabis use and opioid consumption during the first 24 postoperative hours using linear regression on log-transformed opioid consumption with a propensity score-based method (inverse probability of treatment weighting [IPTW]) adjusting for confounders. We further adjusted for imbalanced confounding variables after IPTW was applied., Results: In total, 1683 of 34,521 patients were identified as cannabis users. Cannabis use was associated with increased opioid consumption, with an adjusted ratio of geometric means (95% confidence interval [CI]) of 1.30 (1.22-1.38; P < .0001) for cannabis users versus nonusers. Secondarily, (1) cannabis use was associated with increased TWA pain score, with a difference in means of 0.57 (95% CI, 0.46-0.67; P < .0001); (2) cannabis use was not associated with TWA Sp o2 /F io2 , with an adjusted difference in means of 0.5 (95% CI, -3.1 to 4.2; P = .76); and (3) cannabis use was not associated with a collapsed composite of pulmonary complications, with estimated odds ratio of 0.90 (95% CI, 0.71-1.13; P = .34)., Conclusions: Adult cannabis users undergoing surgeries were found to have significantly higher postoperative opioid consumption and pain scores than nonusers. Cannabis use did not have a clinically meaningful association with hypoxia or composite pulmonary complications., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Behavioral economic demand for cannabis and alcohol is robustly associated with cannabis use and alcohol use, respectively. However, few studies have examined the contributions of cannabis and alcohol demand to simultaneous cannabis and alcohol use, which is common among young adults. We examined prospective associations of cannabis demand and alcohol demand with propensity for simultaneous use (broadly defined as using both cannabis and alcohol in the same day) and with cannabis and alcohol consumption during simultaneous use days among young adults. Young adults reporting simultaneous use ( N = 107) completed a Marijuana Purchase Task assessing cannabis demand and an Alcohol Purchase Task assessing alcohol demand. They then completed daily smartphone surveys over 21 days assessing cannabis and alcohol use. Multilevel models revealed that higher cannabis demand (i.e., higher O max , P max , and intensity; lower elasticity) was uniquely associated with greater propensity for simultaneous use relative to nonuse. In addition, higher alcohol demand (lower elasticity) was uniquely associated with greater propensity for simultaneous use relative to cannabis-only use, and higher cannabis demand (higher break point and intensity, lower elasticity) was uniquely associated with greater propensity for simultaneous use relative to alcohol-only use. Furthermore, in models limited to simultaneous use days, greater cannabis demand (higher O max , lower elasticity) and lower alcohol demand (higher elasticity) were uniquely associated with greater overall cannabis flower consumption, and higher alcohol demand (higher O max , lower elasticity) was uniquely associated with greater overall alcohol consumption. Results suggest that individual differences in cannabis and alcohol demand may contribute to simultaneous cannabis and alcohol use behaviors in a substance-specific pattern. Furthermore, cannabis demand may more strongly drive the tendency to engage in simultaneous use (vs. nonuse) relative to alcohol demand. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Given that cannabis and e-cigarettes are among the most commonly used substances among young people, there is a need to identify risk factors for concurrent cannabis consumption and nicotine vaping among youth and young adults., Methods: Data were obtained from the Truth Longitudinal Cohort, collected from September 2020 to March 2021, among a cohort aged 15-24 years (N = 6379). Chi-square tests were conducted to detect differences in sample characteristics by dual use status (never e-cigarette and never cannabis users, never cannabis and former/noncurrent e-cigarette users, never e-cigarette and former/noncurrent cannabis users, former/noncurrent e-cigarette and cannabis users, current e-cigarette only users, current cannabis only users, and concurrent cannabis and e-cigarette dual users). Multinomial logistic regression was used to determine key demographic variables predicting dual use status., Results: Household tobacco use (Relative Risk Ratio, RRR = 4.93), higher sensation seeking (RRR = 3.98), and mental health score (RRR = 2.58) were associated with higher risk of dual use. Being 15-17 years (RRR = 0.22), being female (RRR = 0.59) and having parents with an education level of some college or more (RRR = 0.64) were associated with lower risk of dual use., Conclusion: Findings suggest the need to carefully monitor cannabis and vaping nicotine among young people. The identification of risk factors provides additional guidance for prevention and treatment efforts, suggesting the need to address use of both substances and target those most at risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Little is known about the prevalence and predictors of adolescents' intention to quit or reduce use of e-cigarettes and/or cannabis., Methods: Frequencies of intention to change (quit, reduce) e-cigarettes and/or cannabis use were examined among 23,915 surveyed middle and high school students with sole and co-use. Predictors of intention to change were identified via LASSO/multilevel logistic regression., Results: Among those with sole e-cigarette use (n = 543), 40.9 % intended to quit and 24.1 % intended to reduce; non-daily e-cigarette use predicted intention to quit and reduce e-cigarettes (p's < 0.03). Among those with sole cannabis use (n = 546), 10.6 % intended to quit and 25.1 % intended to reduce; absence of cannabis cravings predicted intention to reduce cannabis use (p < 0.01). Among those with co-use (n = 816), 26.2 % intended to either quit or reduce (quit/reduce) both substances, 27.5 % intended to quit/reduce e-cigarettes only, and 6.9 % intended to quit/reduce cannabis only. No predictors emerged for intention to change e-cigarette use among those with co-use (p's > 0.09), but younger age, lack of poly-tobacco use, and lack of cannabis craving predicted intention to quit/reduce cannabis use (p's < 0.04)., Conclusions: More than half of adolescents with past-month e-cigarette use, regardless of concurrent cannabis use, expressed interest in changing their use. However, only heaviness of e-cigarette use emerged as a predictor of intention to change suggesting. While fewer students expressed interest in changing their cannabis use, cannabis cravings and poly-tobacco use predicted intent to change. Overall, findings emphasize the need to tailor interventions towards adolescents engaging in more problematic substance use patterns., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Co-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., Methods: Combining 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., Results: While 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., Conclusions: Denormalization 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Objective: To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021., Methods: We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking., Results: At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21-3.84) and Hispanic (HR: 1.72; 95% CI: 1.08-2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16-2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42-0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40-19.45), NHB (HR: 3.14; 95% CI: 1.32-7.46), and Hispanic (HR: 2.99; 95% CI: 1.80-4.97) participants., Conclusions: Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Pregaming is common among college students and is associated with heavy drinking and negative alcohol-related consequences. The use of cannabis on pregaming days may exacerbate negative alcohol-related consequences, and the ordering of when cannabis is used on these days may buffer against or intensify these consequences. Considering the growing rates of simultaneous use of cannabis and alcohol among college students, it is necessary to examine the role of pregaming behaviors in the context of cannabis use and its effects on alcohol-related consequences., Method: In the present study, college students ( N = 485) completed a baseline survey and 14 days of daily surveys, reporting on daily alcohol and cannabis use and alcohol-related negative consequences. Multilevel structural equation models were fit to evaluate cannabis outcomes on pregaming versus non-pregaming drinking days and ordering effects on alcohol-related consequences, controlling for number of drinks, age, and sex., Results: Across all drinking days, pregaming on that day as well as cannabis use during drinking on that day were associated with a greater risk for alcohol-related consequences. On days that did not involve pregaming, the use of cannabis before drinking was associated with a greater risk for negative alcohol-related consequences, whereas cannabis use after drinking was associated with less risk for consequences. These effects were observed on non-pregaming days only and not on days with pregaming., Conclusions: Findings have implications for brief interventions with students, as analyses suggested that both cannabis use and pregaming--independent of number of drinks consumed--are risky behaviors associated with alcohol-related consequences.

Background: Young adults in the United States, including college students, have the highest prevalence of cannabis use compared with other age groups. Although cannabis vaping is increasingly prevalent during young adulthood, little is known about factors contributing to the onset of cannabis vaping during this developmental period., Methods: Participants were 3085 cannabis vaping naïve young adults aged 18-25 years (M = 20.60; SD = 1.80), initially recruited from 24 Texas colleges and participating in a multi-wave, longitudinal study. A survival analysis was conducted to determine if participants reporting elevated depressive symptoms had an increased risk of onset of cannabis vaping over six follow-up waves from fall 2015 to spring 2019 compared to their peers with lower levels of depressive symptoms. Socio-demographic characteristics, time-varying past 30 day substance use, and time-varying peer nicotine vaping were included as covariates in the model., Results: Twenty-five percent of participants initiated cannabis vaping during the four-year study period, with stable initiation rates from 2015 to 2017 but doubling from 2017 to 2019. Analyses, both unadjusted and adjusted for study covariates, indicated that elevated depressive symptoms were significantly associated with an increased risk of cannabis vaping initiation., Conclusion: Findings indicate that initiation of cannabis vaping during young adulthood is common, and particularly more likely among those with greater depressive symptoms, thus underscoring the importance of prevention programs that include mental health support services tailored to young adults., Competing Interests: Declaration of Competing Interest MHB was a consultant in litigation that involved the vaping industry., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Aims: High-potency cannabis has been associated with increased risk of psychosis, but a lack of prospective data hinders understanding of causality in this relationship. This study aimed to combine prospective report of cannabis use with retrospective report of potency to infer the potency of cannabis used in adolescence and explore whether use of cannabis, and the use of high-potency cannabis, in adolescence is associated with incident psychotic experiences., Design: Population-based birth cohort study., Setting: United Kingdom., Participants: n = 5570 participants who reported on any cannabis use (yes/no) age 16 and 18 years, and n = 1560 participants from this group who also retrospectively reported on cannabis potency., Measurements: In questionnaires at ages 16 and 18, individuals self-reported lifetime cannabis use, and at age 24, participants reported the type of cannabis they most commonly used in the whole time since first using cannabis. Psychotic experiences were assessed at age 24 years using the semi-structured Psychosis-Like Symptom Interview, with incident defined as new-onset occurring between ages 19 and 24 years., Findings: Use of high-potency cannabis at age 16 or 18 was associated with twice the likelihood of experiencing incident psychotic experiences from age 19-24 (Odds Ratio 2.15, 95% Confidence Intervals 1.13-4.06). There was less evidence for an effect of any cannabis use on incident psychotic experiences (Odds Ratio 1.45, 95% Confidence Intervals 0.94-2.12)., Conclusions: Use of high-potency cannabis appears to be associated with increased likelihood of psychotic experiences., (© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Introduction: Cannabis and nicotine/tobacco products (NTP) are commonly co-used in adolescence and young adulthood; however, limited research has been done on predictive health behaviors to co-use. The current study is a preliminary investigation into the relationships of modifiable health behaviors on cannabis and NTP co-use in adolescents and young adults., Method: 221 participants (ages 16-22) were characterized into cannabis use only (N = 55), NTP use only (N = 20), cannabis and NTP co-use (used cannabis and NTP; N = 96) and control (no use; N = 50) groups based on past 30-day use. Self-report measures for physical activity, sleep quality, mental health, and reward responsivity were utilized. Participants were given a comprehensive neurocognitive battery. Logistic regressions of self-report measures and fluid intelligence composite scores on substance use group status were run stratified by sex., Results: Higher approach reward sensitivity traits were associated with increased likelihood of cannabis use only (Odds Ratio (OR) = 1.15, p = .036) in female participants. Increased aerobic activity was associated with decreased likelihood of cannabis use only (OR = 0.91, p = .047) and cannabis and NTP co-use (OR = 0.88, p = .007) in female participants. Higher anxiety was associated with increased likelihood of cannabis NTP co-use (OR = 1.51, p = 0.025) in male participants., Discussion: Several health behaviors were linked with cannabis use and cannabis and NTP co-use in both females and male adolescents and young adults. Health markers differed by sex suggesting differing mechanisms of substance co-use. This study informs targetable health behaviors for prevention and intervention efforts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Regular cigarette smoking and cannabis consumption are strongly positively related to each other, yet few studies explore their underlying variation and covariation. We evaluated the genetic and environmental decomposition of variance and covariance of these two traits in twin data from three countries with different social norms and legislation. Data from the Netherlands Twin Register, FinnTwin12/16, and the Minnesota Center for Twin Family Research (total N = 21,617) were analyzed in bivariate threshold models of lifetime regular smoking initiation (RSI) and lifetime cannabis initiation (CI). We ran unstratified models and models stratified by sex and country. Prevalence of RSI was lowest in the Netherlands and prevalence of CI was highest in Minnesota. In the unstratified model, genetic (A) and common environmental factors (C) contributed substantially to the liabilities of RSI (A = 0.47, C = 0.34) and CI (A = 0.28, C = 0.51). The two liabilities were significantly phenotypically (rP = 0.56), genetically (rA = 0.74), and environmentally correlated in the unstratified model (rC = 0.47and rE = 0.48, representing correlations between common and unique environmental factors). The magnitude of phenotypic correlation between liabilities varied by country but not sex (Minnesota rP ~ 0.70, Netherlands rP ~ 0.59, Finland rP ~ 0.45). Comparisons of decomposed correlations could not be reliably tested in the stratified models. The prevalence and association of RSI and CI vary by sex and country. These two behaviors are correlated because there is genetic and environmental overlap between their underlying latent liabilities. There is heterogeneity in the genetic architecture of these traits across country., (© 2024. The Author(s).)

Objective: This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users., Methods: Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use., Results: 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users., Conclusions: Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Cannabis demand (i.e., relative value) is usually assessed as a trait-level risk-factor for cannabis use and consequences. This study examined within-person variability in day-level intensity (i.e., amount consumed at zero cost) and O max (i.e., maximum cannabis expenditure) and tested hypotheses that demand would be positively associated with day-level cannabis use., Methods: Young adults (n=85) reporting past-month simultaneous alcohol and cannabis use completed two daily surveys for 30 days. Morning surveys assessed prior-day cannabis use and evening surveys assessed day-level demand (i.e., intensity, O max ). Multilevel models tested day-level effects of intensity and O max on any cannabis use and flower use frequency and quantity (i.e., grams)., Results: Approximately 52 % and 46 % of variability in intensity and O max , respectively, was due to within-person change. At the day-level, higher intensity and O max were associated with higher likelihood of any cannabis use, regardless of formulation; O max was associated with use of flower in particular; and intensity was associated with the highest quantity of use. At the person-level, only O max was associated with flower use likelihood, and only intensity was associated with flower quantity across days., Conclusions: Cannabis demand demonstrated day-to-day variability, conceivably in response to various internal states and external factors. Intensity and O max were related to elevated likelihood of using any cannabis, particularly flower, at the day-level. Overall, these data illustrate the validity and utility of brief cannabis demand measures, which might be used to further understand cannabis' reinforcing value at a fine-grained level., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2024. Published by Elsevier B.V.)

Background: Few 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., Method: Cross-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., Results: Among 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 %)., Conclusions: Screening 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., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bonnie Halpern-Felsher is a paid expert scientist in some litigation against the e-cigarette industry and an unpaid scientific advisor and expert regarding some tobacco-related policies. No other authors have any conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The current study used U.S. young adult data to examine overall and age group-specific historical trends in (a) mean perceived risk and disapproval of cannabis use, and (b) risk/use and disapproval/use associations., Methods: Data were collected from 2011 to 2022 from 16,492 respondents aged 19-30 in the national Monitoring the Future panel study. Trends in mean risk and disapproval overall and by age group (19-22, 23-26, 27-30) were modeled. Models regressing any past 30-day cannabis use on risk and disapproval controlled for sex, race/ethnicity, college education, population density, state cannabis policy, region, and year. Age group differences and historical trends in regression estimates from year-specific models were examined., Results: From 2011 to 2022, overall mean perceived risk decreased from 3.08 (just over moderate) to 2.50 (between slight and moderate); mean disapproval decreased from 2.21 (between disapprove and strongly disapprove) to 1.66 (between don't disapprove and disapprove). Higher risk and disapproval were independently associated with lower odds of past 30-day cannabis use overall (AORs 0.86 and 0.76, respectively); controlling for sociodemographics and state policy had virtually no impact on association strength. There were no significant age-related association differences. The risk/use association weakened from AOR 0.84 in 2011 to AOR 0.91 in 2022; the disapproval/use association remained stable (AORs 0.753 and 0.749)., Conclusions: Young adults now perceive cannabis as less risky and are less disapproving of using than they were a decade ago. Perceived risk has weakened as a cannabis use risk factor over time; disapproval has remained a stable risk factor., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Increasing number of current cannabis users report using a vaporized form of cannabis and young adults are most likely to vape cannabis. However, the number of studies on cannabis vaping is limited, and predictors of cannabis vaping among U.S. young adults remain unclear. Previous studies on cannabis vaping have known limitations, as they (1) relied heavily on regression-based approaches that often fail to examine complex and non-linear interactive effects, (2) focused on examining cannabis vaping initiation but not on its use over multiple years, and (3) failed to account for recreational cannabis legalization (RCL) status., Methods: This study was a secondary analysis of the restricted use files of the Population Assessment of Tobacco and Health Study, Waves 4-6 (December 2016-November 2021). A two-stage machine learning approach, which included Least Absolute Shrinkage and Selection Operator (LASSO) and Classification and Regression Tree (CART), was used to identify predictors of multi-year cannabis vaping while accounting for state-level RCL status among a representative sample of U.S. young adults., Results: Stratified CART created a five-terminal-node prediction model for states with RCL (split by cannabis use, cigarette use, bullying behavior, and ethnicity) and a different five-terminal-node prediction model for states without RCL (split by cannabis use, heroin use, nicotine vaping, and hookah use)., Conclusions: Characteristics predicting multi-year cannabis vaping appear to differ from those of cannabis vaping initiation. Results also highlight the importance of accounting for RCL status because predictors of cannabis vaping may differ for individuals living in states with and without RCL., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Youth e-cigarette use remains a public health concern and many youth want to quit. However, cannabis use is common among youth who use e-cigarettes, which may interfere with nicotine cessation efforts. This study aimed to investigate cannabis use among youth who vape nicotine and are motivated to quit nicotine., Methods: Connecticut youth (N=223, M age  = 17.3 [SD=1.7] years) who completed an intake for a vaping cessation study reported on their nicotine vaping, cannabis products used, reasons for use, frequency of use, and readiness to quit cannabis. Descriptives characterized population. Regressions were used to examine association of cannabis use and nicotine vaping., Results: Most reported cannabis use (lifetime: 92.4 %; past-month: 68.6 %). Cannabis smoking and vaping were highly prevalent (smoking: lifetime - 90.8 %, current - 63.6 %; vaping: lifetime - 90.8 %, current - 63.1 %). Most reported preferring smoking cannabis (58.7 %) over other routes of administration. Common reasons for cannabis use, were psychoactive (e.g., getting high), physical (e.g., improving sleep), and social (e.g., partying). Cannabis use frequency and preferring smoking cannabis (vs. other modes) was positively associated with more frequent nicotine vaping (ps < 0.05). Participants averaged 6.3 (of 10) on a readiness to quit cannabis scale, a moderate desire to quit., Conclusions: Cannabis use across multiple routes of administration was common among youth seeking help quitting vaping nicotine. Heaviness of cannabis and nicotine use appear to be associated, raising interesting harm-reduction challenges for those seeking to quit nicotine vaping. Understanding cannabis and nicotine co-use is important for targeting treatment for use of both substances., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To descriptively assess cannabis perceptions and patterns of use among older adult cancer survivors in a state without a legal cannabis marketplace. Methods: This study used weighted prevalence estimates to cross-sectionally describe cannabis perceptions and patterns of use among older (65+) adults ( N = 524) in a National Cancer Institute-designated center in a state without legal cannabis access. Results: Half (46 % ) had ever used cannabis (18% following diagnosis and 10 % currently). Only 8% had discussed cannabis with their provider. For those using post-diagnosis, the most common reason was for pain (44%), followed by insomnia (43%), with smoking being the most common (40%) mode of use. Few (<3%) reported that cannabis had worsened any of their symptoms. Discussion: Even within a state without a legal cannabis marketplace, older cancer survivors might commonly use cannabis to alleviate health concerns but unlikely to discuss this with their providers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R. L. T. conducted consultation work with the American Society of Addiction Medicine.

Background: Cannabis legalization has made cannabis accessible via dispensaries which sell a wide variety of cannabis products. Importantly, the various routes of administration are associated with differing consequences. As such, it's crucial to understand the prevalence and correlates of different cannabis products. Unfortunately, research has yet to examine the prevalence of certain forms of cannabis use, and little is known about the prevalence of using multiple forms of cannabis, and whether individual-level factors are associated with using different forms of cannabis., Methods: The current study uses data from the 2022 National Survey on Drug Use and Health (NSDUH) to examine the prevalence and correlates of eight different types of cannabis use (smoking, vaping, eating/drinking, dabbing, drops/lozenges, topical, pills, and other), as well as a cannabis variety scale, on samples of adult and adolescent cannabis users., Results: The results suggest that certain routes of administration are more prevalent than others and that these patterns are fairly consistent between adults and adolescents. Similarly, for both adults and adolescents, the majority of users used more than one cannabis product. Lastly, several individual-level factors are associated with the various forms of cannabis use and many of these associations vary by the route of administration examined., Conclusions: The results of the current study demonstrate that there are differences among cannabis users. If we can develop an understanding of who uses the various forms of cannabis, we could identify the users of the more dangerous forms and provide these individuals with more resources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Aims: Cannabis and nicotine (tobacco or e-cigarettes) use commonly co-occurs and understanding their relationship can help to inform public health strategies to prevent their harms. We conducted a systematic review and meta-analysis to estimate the association of cannabis use given prior nicotine use and vice versa., Methods: PubMed, Embase, PsycINFO, Google Scholar and a hand-search were conducted in 2023 for longitudinal studies of the general population with no restrictions in settings (locations). Random-effects meta-analysis was conducted to estimate odds ratios between cannabis and nicotine use in both directions. The impact of unmeasured confounding was assessed using E-values., Results: From 5387 identified records, we included 20 studies. Among cannabis-naïve youths, baseline use of any nicotine products was positively associated with initiation of any cannabis use at follow-up [odds ratio (OR) = 5.39, 95% confidence interval (CI) = 3.19, 9.11; adjusted OR (aOR) = 2.59, 95% CI = 2.01, 3.32]. In nicotine-naïve participants (youths + adults), baseline cannabis use was positively associated with the initiation of any nicotine use at follow-up (OR = 4.08, 95% CI = 2.05, 8.11; aOR = 2.94, 95% CI =1.54, 5.61). There were no significant associations between baseline cannabis use and subsequent initiation of any nicotine (aOR = 3.29, 95% CI = 0.85, 12.76) or daily nicotine use (aOR = 2.63, 95% CI = 0.41, 16.95) among youths. The median E-values were 5.5 for nicotine exposure and cannabis use initiation and 4.1 for cannabis exposure and nicotine use initiation, indicating that substantial unmeasured confounding would need to have a strong association with both outcomes to fully explain away the cannabis and nicotine relationship., Conclusion: Although the evidence for associations between cannabis use and tobacco use is mixed, a majority of studies to date have found that cannabis use is associated with prior nicotine use and vice versa., (© 2024 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Objective: Examine if concerns for police brutality, societal discrimination, and school shootings relate to subsequent cigarette and cannabis use among Hispanic and non-Hispanic White (NHW) youth. Hispanic youth may be particularly vulnerable to such concern., Methods: Data are from the University of Southern California's Happiness and Health Survey, a prospective cohort study, which followed Hispanic (N = 1007) and NHW (N = 251) students from ten inner-city and suburban high schools in Los Angeles County, starting from 2013 until 2019. Participants reported concern, worry, and stress levels regarding police brutality, societal discrimination, and school shootings. Four categories were created to indicate levels of each concern variable over time (consistently low, decreased, increased, and consistently high). Associations with past-30-day cannabis, blunt, THC-oil, and cigarette use in 2019 were assessed. Separate models for each racial/ethnic category were used., Results: Among Hispanic participants, reporting consistently high concern about police brutality (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 1.69, 95% CI = 1.18-2.40), smoke blunts (aOR = 1.63, 95% CI = 1.11-2.39), and vape THC-oil (aOR = 1.67, 95% CI = 1.14-2.44). Hispanic participants who reported consistently high concern for societal discrimination also had higher odds (vs. consistently low concern) to subsequently smoke blunts (aOR = 1.54, 95% CI = 1.04-2.29) and vape THC-oil (aOR = 1.65, 95% CI = 1.12-2.43). Among NHW participants, increasing concern over school shootings (vs. consistently low concern) was associated with higher odds to subsequently smoke cannabis (aOR = 2.98, 95% CI = 1.08-7.70)., Conclusions: Concerns for police brutality, societal discrimination, and school shootings were associated with cannabis use especially among Hispanic participants. Providing Hispanic youth with healthy coping strategies may reduce cannabis use., Competing Interests: Declarations Ethics Approval The current study was approved by the institutional review board of the University of Southern California, which follows Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cross-sectional studies in addition to the American Association for Public Opinion Research (AAPOR) reporting guidelines for surveys. Consent to Participate Informed consent was obtained from all individual participants included in the study. Competing Interests The authors declare no competing interests. Public Health Significance Statement This study indicates that concerns over police brutality and social injustice are increasing marijuana smoking, blunt smoking, and THC-oil vaping among Hispanic adolescents., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: Cannabis use is prevalent among cancer patients and survivors and may provide some therapeutic benefits for this population. However, benefits may be attenuated when cannabis is co-used with tobacco, which is associated with more severe tobacco and cannabis use and adverse outcomes in noncancer populations. We compared cannabis use, primary mode of use, and therapeutic and/or nontherapeutic use among 3 groups of patients and survivors based on cigarette smoking status., Methods: Survey data was collected from patients and survivors with cancer (n = 1732) at 2 US National Cancer Institute-designated cancer centers in states with varying cannabis regulatory policy. Prevalence of cannabis use (prior to diagnosis, after diagnosis, before treatment, after treatment), primary mode of use, and therapeutic and/or nontherapeutic use were assessed by cigarette smoking status (current, former, never) within and across centers using weighted bivariate analyses and multivariable logistic regression, controlling for demographic and clinical variables., Results: Current cigarette use was associated with greater rates of cannabis use prior to diagnosis, after diagnosis, during treatment, and after treatment within each center (all P < .001) and in pooled analyses across centers (all P < .001). Primary mode of use, knowledge of cannabis products, and therapeutic and/or nontherapeutic use also statistically differed by tobacco status and study site., Conclusions: Results illustrate the importance of conducting assessments for both tobacco and cannabis use among cancer patients during and after cancer treatment, regardless of the cannabis regulatory environment. Given previous data indicating harms from co-use and continued tobacco use during cancer treatment, this issue introduces new priorities for cancer care delivery and research., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Rates of cannabis initiation among teenagers and young adults are increasing. Further, the use of various forms of cannabis (smoked or vaped) with nicotine (dual use) is increasingly common among young people. The health effects of dual use are lesser known, particularly in the context of high-potency cannabis products and across different routes of administration, which is ominous in terms of predicting future health outcomes. There is a long history of cannabis use being associated with decreased activity and increased snacking, both of which could portend an increased risk of metabolic and cardiovascular disease, particularly when these habits begin during formative years. However, modern forms of cannabis may not have these same effects. Here, we assess whether cannabis use alone and dual use of cannabis with nicotine impact dietary and exercise habits in young people. An anonymous, social media-based survey was designed based on the UC San Diego Inhalant Questionnaire and published diet and exercise questionnaires. A total of 457 surveys were completed. Young sole cannabis users represented 29% of responders, 16% were dual users of cannabis and nicotine, and 55% were non-users of either drug. Although the sole use of cannabis was not associated with dietary or activity differences relative to non-users, dual users of cannabis and nicotine reported higher consumption of unhealthy sugars. This novel finding of dual use being associated with increased sugar intake in young people raises concerns for an increased risk of metabolic syndrome and cardiovascular disease in this population.

Introduction: Cigarette smoking continues to decline in the U.S., but cannabis use is increasing. Many people who smoke cigarettes also use cannabis. This study examines the characteristics of persons who co-use and those who do not co-use and the likelihood of quitting cigarettes for callers to Kick It California, a large state tobacco quitline., Methods: Data were examined from Kick It California callers from January 2020 through December 2023 (N=45,151), including those from a subgroup randomly sampled and reached for evaluation at 7 months after quitline enrollment (n=3,545). The rate of cigarette smoking cessation at 7 months after enrollment for people who co-use cannabis was compared with that for people who do not. Analyses started in 2023 and concluded in January 2024., Results: More than a quarter (27.2%) of Kick It California callers co-used cannabis. They were more likely to be male, to be younger, and to have a mental health condition than those who did not. Those who co-use cannabis and those who do not have similar rates of receiving quitline counseling or using Food and Drug Administration-approved cessation aids. Controlled for effects of personal characteristics and use of smoking-cessation services, people who co-use cannabis were less likely to quit cigarette smoking 7 months after enrollment (23.2% vs 28.9%; p<0.001). Among those who co-use, 42.9% intended to quit using cannabis in the next 30 days., Conclusions: A substantial percentage of tobacco quitline callers use cannabis. Those who do co-use quit cigarette smoking at a lower rate than those who do not. Over 40% of people who co-use reported intention to quit cannabis, making tobacco quitlines a rich environment to learn about people who co-use and develop strategies for intervention., (Copyright © 2024 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Hemp-based psychoactives comprise a burgeoning legal substance market with rising trends in use across the U.S. and Canada as well as parts of Europe. Currently, scant empirical research on the use of these Novel Psychoactive Substances (NPS) exists. By examining policy, market conditions, consumer uptake, and related risks, this research extends theory on drug trends by describing the regulatory environments that shape the emergence and popularity of psychoactive hemp-based products among young adults., Methods: Relying on ethnographic fieldwork of hemp-based markets across 3 U.S. state hemp and cannabis policy contexts as well as in-depth interviews with 40 young adult cannabis consumers recruited across 10 U.S. states, we examined how regulatory conditions shape hemp-based psychoactive markets, trends in their use, and associated risks., Results: Young adults are motivated to consume hemp-based psychoactives due to the regulatory and market environments that facilitate the production of highly potent products that are inexpensive and easily accessible. States that regulate hemp-based psychoactives as cannabis, do not provide hemp markets with a competitive advantage and as such see minimal uptake. In the absence of hemp specific policies, substantial variations in product potencies, insufficient dosing information, and unscrupulous product packaging practices may increase related risks., Conclusion: Trend theory provides insight into the complex relationships that exist between drug policy, markets, and the proliferation of legal highs. Understanding the contextual significance that both market and regulatory conditions have on legal drug production, distribution, and consumption may better inform approaches to reduce the risks commonly associated with novel psychoactive substances like hemp-based psychoactives., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Polysubstance use is associated with adverse health outcomes, yet little research has measured changes in polysubstance use. We aimed to 1) estimate trends in marijuana and heavy alcohol use by cigarette smoking and demographic subgroups, and 2) examine patient factors associated with concurrent use among adults who were smoking., Methods: We conducted a repeated cross-sectional analysis of 687,225 non-institutionalized US adults ≥18 years from the 2002-2019 National Survey on Drug Use and Health. Participants were stratified into current, former, and never smoking groups. Main outcomes were prevalence of heavy alcohol use, marijuana use, and concurrent use of both substances., Results: From 2002-2019, heavy alcohol use declined from 7.8 % to 6.4 %, marijuana use rose from 6.0 % to 11.8 %, and concurrent use of alcohol and marijuana remained stable. Among adults who were smoking from 2005 to 2019, higher education was associated with higher odds of heavy alcohol use, while older ages, female gender, non-White race/ethnicity, and government-provided health insurance were associated with lower odds. The odds of marijuana use decreased in females, older ages, and higher incomes while increasing in people with poorer health status, higher education, government-provided or no health insurance, and serious mental illness. Compared to White adults who were smoking, Black counterparts had higher odds of marijuana use (OR=1.23; 95 %CI: 1.15-1.29), while Hispanic (OR=0.68; 95 %CI: 0.63-0.72) and other racial/ethnic identities (OR=0.83; 95 %CI: 0.77-0.90) had lower odds., Conclusions: Our study suggests marijuana use might not be sensitive to changes in the use of tobacco and alcohol., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Jacob James Rich is a policy analyst at Reason Foundation., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: In legal and illegal markets, high-potency cannabis (>10 % delta-9-tetrahydrocannabinol (THC)) is increasingly available. In adult samples higher-potency cannabis has been associated with mental health disorder but no studies have considered associations in adolescence., Methods: A population-wide study compared no, low and high potency cannabis using adolescents (aged 13-14 years) self-reported symptoms of probable depression, anxiety, and auditory hallucinations., Results: Of the 6672 participants, high-potency cannabis was used by 2.6 % (n=171) and low-potency by 0.6 % (n=38). After adjustment for sociodemographic factors, tobacco and alcohol use, in comparison to participants who had never used cannabis, people who had used high-potency but not low-potency cannabis were more likely to report symptoms of depression (odds ratio 1.59 [95 % confidence interval 1.06, 2.39), anxiety (OR 1.45, 95 % CI 0.96, 2.20), and auditory hallucinations (OR 1.56, 95 % CI 0.98, 2.47)., Conclusions: High-potency cannabis use is associated with an increased risk of probable mental health disorders. Services and programming to minimise drug harms may need to be adapted to pay more attention to cannabis potency., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Given diversified cannabis products, we examined associations between cannabis consumption methods and cannabis risk perception of smoking cannabis 1-2 times a week. Using the 2022 U.S. National Survey on Drug Use and Health data (N = 12,796 past-year adult cannabis users; M = 6127 and F = 6669), we used multinomial and binary logistic regression models. Smoking was the most prevalent method, followed by eating/drinking, vaping, and dabbing. One-half of cannabis users reported no perceived risk of smoking cannabis 1-2 times a week, 37.5% perceived slight risk, 9.2% moderate risk, and 2.9% great risk. Those with moderate or great risk perception had a lower likelihood of using 4+ methods of consumption (e.g., RRR = 0.40, 95% CI = 0.20, 0.77 for great risk perception). Any perceived risk was associated with higher odds of edibles/drinks only (e.g., aOR = 2.81, 95% CI = 1.43, 5.54 for great risk perception). Along with medical use and CUD, sociodemographic factors, mental illness, and other substance use were also significant correlates of cannabis consumption methods. Understanding the varying risk perceptions associated with different consumption methods is needed for harm reduction initiatives. More research is needed on cannabis products, particularly edibles/drinks and dabs/concentrates, to better understand the potential risks associated with them.

Background: Despite an increase in the varieties of cannabis products available for consumption, limited evidence is available about the patterns of cannabis consumption methods before and after legalization. Objectives: To examine the changes in modes of cannabis use and their correlates among adults in Ontario, Canada both prior to and following cannabis legalization in 2018. Methods: Data were utilized from the 2017 to 2022 Centre for Addiction and Mental Health's (CAMH) Monitor study, a repeated cross-sectional survey of adults 18 years of age and older ( n  = 2,665; 56% male). The surveys employed a regionally stratified sampling design using computer-assisted telephone interviews and web surveys. Multinomial regression was performed to examine different modes of cannabis use. Results: The exclusive use of cannabis through ingestion methods increased from 4.0% in 2017 to 16.6% in 2022 ( p  < .001). However, the exclusive use of inhalation-based cannabis decreased from 49.4% in 2017 to 25.5% in 2022 ( p  < .001). Relative to inhalation-based modes, adults were about five times more likely to use ingestion-based modes in 2020 [RRR = 4.65 (2.94-7.35)] and 2022 [RRR = 4.75 (2.99-7.55)] than in 2019, after accounting for sociodemographic factors. Conclusions: Ingestion-based cannabis use among adults increased fourfold between 2017 and 2022, a period during which recreational cannabis use was legalized in Canada. The increase was especially evident after the legalization of cannabis edibles.

Objective: The current study used U.S. national data to examine trends in cannabis use from 2013 to 2021, focusing on changes in cannabis prevalence during young and middle adulthood and whether trends differed by sociodemographic characteristics., Method: Data from 2013 to 2021 from 21,182 respondents ages 19-30 and 29,871 ages 35-55 in the national Monitoring the Future panel study (followed since they were in 12th grade in 1976-2020) were used to model historical trends in cannabis prevalence (any 12-month use, any 30-day use, and near-daily use [≥20 occasions in the past 30 days])., Results: Prevalence of 12-month, 30-day, and near-daily cannabis use significantly increased from 2013 to 2021 for both young and middle adults. Trends for all three behaviors indicated either consistent linear increases or two-slope increases in which the slope estimate was larger in more recent years. Historical increases in 12-month and 30-day use were similar for young and middle adulthood; the historical increase in near-daily use among middle adults had some evidence for a possible pandemic-related deviation. Historical trends did not differ by race/ethnicity or college degree. Trends for 12-month and 30-day use differed by sex, with women increasing more than men over time, especially during middle adulthood., Conclusions: Significant increases in the prevalence of cannabis use have occurred over the past decade for young and middle adults across sociodemographic groups, with some indication that near-daily use increased among middle adults at the onset of the pandemic. Although men continue to have a higher prevalence than women, the gap has narrowed, with greater increases in cannabis use among women.

Objective: These analyses use data from a 40-year prospective study to extend information into the sixth and seventh decades of life regarding latent trajectory classes of cannabis use and predictors of those classes., Method: Data from the San Diego Prospective Study were analyzed for 329 men of European and Hispanic ethnicity who had used cannabis at about age 23 at study entry (Time 1) and who were interviewed about every 5 years through about age 60 to 70. Latent classes of cannabis use trajectories were evaluated using latent class growth analyses, baseline predictors of class membership were determined, and significant predictors of each class were established using logistic regression analyses., Results: Four latent classes were identified ranging from 12.5% with cannabis use at every follow-up to 25.8% with no use after Time 1. Eight of 14 Time 1 predictors differed significantly across the trajectory classes, including five (age, marital status, religious identity, intensity of cannabis use, and sensation seeking) that significantly contributed to regression analyses when all significant predictors were considered together., Discussion: Forty-two percent of participants continued using cannabis long-term, including one in eight who used it at every follow-up. Predictors of continued use and identification of those most likely to stop required gathering information on a range of demographic, prior substance use, and personality characteristics., Conclusions: Considering the potential enhanced dangers of cannabis use in later life, the high rate of continued use over four decades implies that clinicians should ask all older patients about recent cannabis use, especially if they had used it in their 20s.

Many cannabis users report therapeutic benefits from cannabis consumption, even when not recommended by a physician. To date, few data on therapeutic users of cannabis in France are available. Using a cross-sectional survey held in 2020, we collected sociodemographic, health and substance use data from 4150 daily cannabis users in France. We used multivariable logistic regression to assess factors associated with exclusive therapeutic use of cannabis. Approximately 10% ( n  = 453) of the participants reported using cannabis exclusively for therapeutic purposes. Exclusive therapeutic users of cannabis differed from non-exclusive (i.e. recreational and mixed) users, especially regarding age (aOR [95%CI] = 1.01 [1.00-1.02]), employment (aOR = 0.61 [0.47-0.79]), urban area of residence (aOR = 0.75 [0.60-0.94]), physical (aOR = 2.95 [2.34-3.70]) and mental health condition (aOR = 2.63 [1.99-3.49]), mode of cannabis administration (non-smoked, aOR = 1.89 [1.22-2.95); smoked with little tobacco, aOR = 1.39 [1.09-1.76]), frequency of cannabis use (aOR = 1.04 [1.01-1.06]), home cultivation (aOR = 1.56 [1.13-2.15]), at-ridsk alcohol use (aOR = 0.68 [0.54-0.84]), and previous-month opiate use (aOR = 1.67 [1.22-2.30]). A greater understanding of the distinct profiles of regular cannabis users could inform harm reduction strategies and care access for this population. Further studies are needed to better understand the boundaries between therapeutic and recreational use.

Introduction: Germany is reforming its legal approach to cannabis, allowing the possession and cultivation of cannabis for recreational purposes. The objective of this study is to investigate the impact of the policy reform on (1) The prevalence of cannabis use in the general population and (2) Driving under the influence of cannabis (DUIC) among regular users., Methods and Analysis: A quasi-experimental research design will be employed, with repeated cross-sectional surveys on self-reported DUIC and cannabis use conducted at three measurement points in Germany (intervention group) and Austria (control group) over a 2-year observation period (2023-2025). Data will be collected from approximately 50 000 individuals aged between 18 years and 64 years. To minimise reporting biases in the measurement of DUIC, we will use direct and indirect assessments via crosswise model and motor vehicle accident data from official statistics. In a difference-in-difference framework, regression analyses and interrupted time series analysis will be carried out for hypothesis testing., Ethics and Dissemination: Participants will be informed about voluntary participation, data protection laws and the option to delete data on request. Ethical approval was obtained from the Local Psychological Ethics Committee of the Centre for Psychosocial Medicine in Hamburg, Germany (reference number: 0686). Findings will be disseminated through scientific networks and will be key for a comprehensive evaluation of the cannabis law reform. The findings will facilitate the design and implementation of road safety measures., Competing Interests: Competing interests: JM has worked as consultant for and received honoraria from public health agencies. All other authors do not declare any conflict of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although cannabis was legalized in Canada in 2018 and is one of the most used substances in Canada, few studies have examined how individuals with different patterns of cannabis use differ in their attempts to decrease or abstain from cannabis. The current study examined how groups of cannabis users, which were formed on the basis of demographic characteristics, substance use patterns, mental health symptoms, and self-reported quality of life differed on their experiences with cannabis cessation. A sample of 147 Canadian adult participants who had attempted to decrease or quit cannabis were recruited from the community (n = 84, 57.14%) and crowdsourcing (n = 63, 42.86%). Four profiles of cannabis users emerged using a Latent Profile Analysis: low-risk (n = 62, 42.18%), rapidly escalating high-risk (n = 40, 27.21%), long-term high severity (n = 35, 23.81%), and long-term lower severity (n = 10, 6.80%). Individuals in the rapidly escalating profile had attempted to decrease their cannabis use more times compared to other profiles. More participants in the long-term high severity group found their use stayed the same or got worse after their last cessation attempt, compared to the low-risk group where more individuals indicated their use stopped. The results of the current study indicate that cannabis users differ in their attempts at reducing or ceasing cannabis use and that they may benefit from different intensity of cannabis interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 MacQuarrie, Brunelle. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)