Cannabis-Only Use Nearly Tripled While Cigarette Use Dropped Among U.S. Adults
From 2015 to 2023, cannabis-only use among U.S. adults nearly tripled (3.9% to 10.6%) while cigarette-only use nearly halved (15.0% to 8.8%), with cannabis use more common among higher-income groups.
Quick Facts
What This Study Found
Cannabis-only use increased from 3.9% to 10.6% over 2015-2023, while cigarette-only use declined from 15.0% to 8.8%. Co-use remained stable. Cannabis-only use was more prevalent among college-educated, higher-income, and privately insured adults, while cigarette use concentrated among disadvantaged groups.
Key Numbers
Cannabis-only: 3.9% (2015) → 10.6% (2023). Cigarette-only: 15.0% (2015) → 8.8% (2023). Co-use relatively stable. Cannabis use higher among college-educated, high-income, privately insured adults. Cigarette use higher among lower education, income, uninsured.
How They Did This
Analysis of the National Survey on Drug Use and Health across three periods: 2015-2019, 2020, and 2021-2023. Examined past 30-day cigarette and cannabis use/co-use among U.S. adults 18+. Multivariable logistic regressions identified sociodemographic predictors.
Why This Research Matters
Cannabis is replacing cigarettes as the dominant inhaled substance for many Americans, but with an inverted socioeconomic pattern. This shift carries public health implications since cannabis smoke exposure risks are less well understood than tobacco.
The Bigger Picture
The socioeconomic inversion is striking: cannabis has become a substance of relative advantage, while cigarettes are concentrating among disadvantaged populations. This challenges stereotypes and has implications for how public health campaigns should be targeted.
What This Study Doesn't Tell Us
Self-reported substance use subject to underreporting. Past 30-day use doesn't capture frequency or quantity. Doesn't distinguish smoking from other cannabis methods. Cross-sectional surveys can't track individual changes over time.
Questions This Raises
- ?Will cannabis-only use eventually plateau?
- ?Are there health consequences from substituting cannabis for cigarettes?
- ?How does legalization status affect these socioeconomic patterns?
Trust & Context
- Key Stat:
- Evidence Grade:
- National representative survey data across 8 years with consistent methodology — strong for describing trends though limited in explaining mechanisms.
- Study Age:
- Published in 2026, capturing the most recent available trend data through 2023.
- Original Title:
- Cigarette and cannabis use and co-use among U.S. adults: An examination of prevalence and trends during 2015-2023.
- Published In:
- Addictive behaviors, 172, 108521 (2026)
- Authors:
- Constantin, Joanne, Jayawardhana, Jayani(3)
- Database ID:
- RTHC-08184
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Are more Americans using cannabis than cigarettes now?
Not quite overall, but the gap is closing fast. Cannabis-only use reached 10.6% in 2023 compared to 8.8% cigarette-only use. Among college-educated and higher-income adults, cannabis use already outpaces cigarette use.
Who uses cannabis vs. cigarettes?
Interestingly, the patterns are inverted. Cannabis-only use is more common among college-educated, higher-income, and privately insured adults. Cigarette-only use concentrates among those with lower education, lower income, and no insurance.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08184APA
Constantin, Joanne; Jayawardhana, Jayani. (2026). Cigarette and cannabis use and co-use among U.S. adults: An examination of prevalence and trends during 2015-2023.. Addictive behaviors, 172, 108521. https://doi.org/10.1016/j.addbeh.2025.108521
MLA
Constantin, Joanne, et al. "Cigarette and cannabis use and co-use among U.S. adults: An examination of prevalence and trends during 2015-2023.." Addictive behaviors, 2026. https://doi.org/10.1016/j.addbeh.2025.108521
RethinkTHC
RethinkTHC Research Database. "Cigarette and cannabis use and co-use among U.S. adults: An ..." RTHC-08184. Retrieved from https://rethinkthc.com/research/constantin-2026-cigarette-and-cannabis-use
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.