Three Decades of Data Show Persistent Racial Disparities in Youth Cannabis Use
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Black adolescent cannabis-only use 2.5x higher than White adolescents across three decades
- Evidence Grade:
- Nationally representative survey data spanning 30 years with over 234,000 students; strong because of sample size and longitudinal scope.
- Study Age:
- 2025 publication analyzing 1991-2021 YRBS data
- Original Title:
- Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among U.S. Youth: 1991-2021.
- Published In:
- Journal of racial and ethnic health disparities (2025)
- Authors:
- Dai, Hongying Daisy(2)
- Database ID:
- RTHC-06290
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Why do Black adolescents have higher cannabis use but lower tobacco use?
The study documents the pattern but does not explain it. Possible factors include cultural norms, marketing targeting, neighborhood availability, and differential policy enforcement. These patterns have been remarkably consistent over 30 years.
What does co-use mean for health risk?
Using both cannabis and tobacco together compounds health risks, particularly for lung health. The high co-use rate among AI/AN youth (20.1%) suggests a need for integrated prevention approaches addressing both substances.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06290APA
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
MLA
Dai, Hongying Daisy. "Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among U.S. Youth: 1991-2021.." Journal of racial and ethnic health disparities, 2025. https://doi.org/10.1007/s40615-025-02284-1
RethinkTHC
RethinkTHC Research Database. "Trends in Cannabis and Tobacco Use by Racial and Ethnic Grou..." RTHC-06290. Retrieved from https://rethinkthc.com/research/dai-2025-trends-in-cannabis-and
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.