Cannabis use clustered with heavy drinking and tobacco use in distinct patterns among U.S. adults

Four clusters with similar profiles emerged for both men and women: heavy-drinking-tobacco-some-cannabis-use-obese, high-substance-use, obese, and relatively-healthy-lifestyle. The high-substance-use group skewed under age 35. Clusters featuring alcohol, tobacco, and cannabis together were more common in midlife men and higher-income individuals. Clustered risk factors were associated with being White and having no college degree.

Latent class analyses and multinomial/logistic regressions using a nationally representative sample of 214,505 U.S. adults from the 2015-2019 National Survey on Drug Use and Health, stratified by gender.

Most substance use research examines individual substances in isolation, but real-world use involves combinations. Understanding how cannabis clusters with other behavioral risk factors helps design interventions that address multiple behaviors simultaneously.

The clustering of cannabis with tobacco, alcohol, and obesity suggests that single-substance interventions may miss the broader picture. Tailored multibehavior approaches could be more effective for the significant segment of the population affected by these overlapping risk factors.

Cross-sectional design captures a snapshot, not trajectories. Self-reported substance use may be underestimated. NSDUH excludes institutionalized and homeless populations. Latent class solutions involve researcher judgment.