Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 4, 2022
Date Accepted: Feb 7, 2023
Associations between product types and intensity of tobacco and cannabis co-use on the same day among young adult smokers: a smartphone-based daily diary study
ABSTRACT
Background:
Same-day co-use of tobacco and cannabis may increase the extent of use and negative health consequences among young adults. Nuanced understanding of tobacco and cannabis co-use in terms of specific products and intensity is critical to inform prevention and intervention efforts.
Objective:
We examined whether (i) the same routes of administration would facilitate co-use of two substances on the same day, and (ii) participants would use more tobacco on a day when they use more cannabis.
Methods:
A smartphone-based study collected 2,891 daily assessments from 147 cigarette smokers (aged 18-26; 51.7% female) during 30 consecutive days. Daily assessments measured types (cigarettes, cigarillos, e-cigarettes) and intensity of tobacco use (number of cigarettes or cigarillos smoked, and number of times vaping e-cigarettes), and types (combustible, vaporized, edible) and intensity of cannabis use (number of times). Generalized estimating equation models examined day-level associations between types of cannabis use and use of each tobacco product. Multilevel models examined day-level associations between intensities of using cannabis and tobacco.
Results:
Same-day co-use was reported in 989 daily assessments (34.2%), mostly co-use of cigarettes and combustible cannabis (30.6%). Participants were had higher odds of using cigarettes (AOR=1.57, 95% CI=1.09, 2.25), cigarillos (AOR=7.30, 95% CI=4.62, 11.53), and e-cigarettes (AOR=1.45, 95% CI=1.03, 2.03) on days with use of combustible cannabis. They also had higher odds of using e-cigarettes on the days with use of vaporized cannabis (AOR=3.41, 95% CI=1.75, 6.64). Participants reported a greater intensity of using cigarettes (AOR=1.34, 95% CI=1.22, 1.47), cigarillos (AOR=2.02, 95% CI=1.68, 2.43), and e-cigarettes (AOR=1.48, 95% CI=1.16, 1.88) on days when they used more cannabis.
Conclusions:
Types and intensities of tobacco and cannabis use within a day among young adult smokers were positively correlated, including co-use of vaporized products. Prevention and intervention efforts should address co-use and pay attention to all forms of use, including co-use of e-cigarettes and vaporized cannabis, to reduce negative health outcomes. Clinical Trial: NA
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