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.
Public health professionals, policymakers, anyone interested in substance use trends, and people comparing risks of cannabis versus tobacco.
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
National representative survey data across 8 years with consistent methodology — strong for describing trends though limited in explaining mechanisms.
When this study was published
Published in 2026, capturing the most recent available trend data through 2023.
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.
Questions still open
- Will cannabis-only use eventually plateau? Are there health consequences from substituting cannabis for cigarettes? How does legalization status affect these socioeconomic patterns?
Common questions
Are more Americans using cannabis than cigarettes now?
Who uses cannabis vs. cigarettes?
Read the original research
Cigarette and cannabis use and co-use among U.S. adults: An examination of prevalence and trends during 2015-2023.
Addictive behaviors, 172, 108521
Citation
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