Marijuana use modifies the association between heavy alcohol consumption and tobacco use patterns among US adults: Findings from Behavioral Risk Factor Surveillance System, 2020

This study explored the associations of heavy alcohol consumption with current e-cigarette, cigarette and dual use of e-cigarettes and cigarettes among a nationally representative sample of adults in the United States (US), and if these associations are modified by marijuana use.Data from 157,138 adults who participated in the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were included in this cross-sectional analysis. Multinomial logistic regression was used to estimate the strength of the associations between heavy alcohol consumption (independent variable) and the tobacco use patterns (dependent variable, i.e., non-use, current e-cigarette use, current cigarette use and current dual use of e-cigarettes and cigarettes). We also assessed the interaction between past-month marijuana use and heavy alcohol consumption on the primary outcome.After the adjustment for potential confounders, heavy alcohol consumption (relative to no heavy alcohol consumption) was associated with higher odds of current e-cigarette (3.91 [2.25-6.78]), cigarette (3.02 [2.28-3.99]) and dual (4.78 [3.25-7.01]) use. The test for interaction showed that the associations of heavy alcohol consumption with the tobacco use patterns were modified by past-month marijuana use (p 0.05 for all groups), with associations being much stronger among past-month marijuana non-users.Heavy alcohol consumption is positively associated with current e-cigarette, cigarette, and dual use among US adults. Further, the findings indicate that these relationships are modified by past-month marijuana use. Longitudinal research is needed to explore the role of marijuana in the association of heavy alcohol consumption with current e-cigarette, cigarette and dual use among adults.