From 1991 to 2021, Black adolescents consistently had the highest rates of cannabis-only use, while American Indian/Alaska Native youth had the highest rates of cannabis-tobacco co-use.
Public health professionals; prevention program designers; educators working with diverse youth populations
Black adolescent cannabis-only use 2.5x higher than White adolescents across three decades
What the researchers found
During 2015-2021, Black adolescents had 12.6% cannabis-only use (vs 4.9% for White), while AI/AN adolescents had 20.1% cannabis-tobacco co-use (vs 13.4% for White). Black cannabis-only use increased from 10.8% to 12.6% over three decades. Asian adolescents consistently reported the lowest rates.
Why it matters
Substance use prevention programs often use one-size-fits-all approaches, but these 30-year trends show dramatically different patterns across racial and ethnic groups that require tailored interventions.
The numbers in context
234,572 students surveyed. Black cannabis-only use: 12.6% (2015-2021). AI/AN co-use: 20.1%. White cannabis-only: 4.9%. Hispanic: 9.0%. Multi-racial: 8.8%. Asian: lowest across all categories.
How the study worked
Analysis of Youth Risk Behavior Surveys from 1991-2021 covering 234,572 high school students. Multivariable logistic regressions examined racial/ethnic disparities across four time periods.
What this study cannot tell us
Self-reported data from school-based surveys, missing youth not in school. Broad racial/ethnic categories may mask within-group diversity. Cannot distinguish frequency or quantity of use.
How to read the evidence
Nationally representative survey data spanning 30 years with over 234,000 students; strong because of sample size and longitudinal scope.
When this study was published
2025 publication analyzing 1991-2021 YRBS data
The bigger picture
These disparities have persisted for three decades despite changing laws, attitudes, and prevention programs. The pattern where Black youth have high cannabis-only use but low tobacco-only use, while AI/AN youth have high co-use, points to distinct cultural and structural factors.
Questions still open
- What structural factors drive these persistent disparities? Why has AI/AN co-use remained high despite overall tobacco use declines? Are current prevention programs reaching the most affected communities?
Common questions
Why do Black adolescents have higher cannabis use but lower tobacco use?
What does co-use mean for health risk?
Read the original research
Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among U.S. Youth: 1991-2021.
Journal of racial and ethnic health disparities
Citation
Dai, Hongying Daisy. (2025). Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among U.S. Youth: 1991-2021.. Journal of racial and ethnic health disparities. https://doi.org/10.1007/s40615-025-02284-1
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