Nearly half of young adult cannabis users mix tobacco with cannabis, and mixing more frequently was associated with greater nicotine dependence even after accounting for other nicotine sources.
Young adult cannabis users, tobacco cessation counselors, and public health researchers.
48% of cannabis users mixed tobacco with cannabis
What the researchers found
Of 313 past-year cannabis users (mean age 30.6), 48% reported mixing tobacco with cannabis. Weekly or daily mixing was associated with endorsing 0.5 more ICD-10 nicotine dependence criteria, and less-than-weekly mixing with 0.3 more criteria, after controlling for cigarettes smoked, other tobacco products, and secondhand smoke exposure.
Why it matters
Mixing tobacco with cannabis creates an often-overlooked source of nicotine exposure that could make quitting tobacco harder for young adults who use both substances.
The numbers in context
788 participants total, 313 past-year cannabis users, 150 (48%) reported mixing. Weekly/daily mixers: 0.5 additional ND criteria. Less than weekly mixers: 0.3 additional criteria.
How the study worked
Longitudinal cohort study of 788 young adults (2017-2020) using self-report questionnaires. Multivariable logistic regression identified characteristics of mixers. Nicotine dependence was measured using ICD-10 criteria.
What this study cannot tell us
Self-reported measures. Longitudinal design but nicotine dependence analysis was cross-sectional within the cannabis-using subsample. Canadian context where mixing may be more common than in the U.S.
How to read the evidence
Longitudinal cohort with appropriate controls for other nicotine sources, though the mixing-dependence analysis was cross-sectional.
When this study was published
Published in 2022 with data from 2017-2020.
The bigger picture
Tobacco control efforts may be undermined if cannabis-tobacco mixing is not recognized as an independent pathway to nicotine dependence, especially in regions where mixing is culturally common.
Questions still open
- Would reducing tobacco-cannabis mixing rates improve tobacco cessation outcomes? Are cannabis users who mix aware of the nicotine dependence risk?
Common questions
Who is most likely to mix tobacco with cannabis?
Does mixing make nicotine dependence worse?
Read the original research
Who mixes tobacco with cannabis and does mixing relate to nicotine dependence?
Addictive behaviors, 128, 107254
Citation
Dugas, Erika N; Wellman, Robert J; Sylvestre, Marie-Pierre; Bélanger, Richard E; O'Loughlin, Jennifer. (2022). Who mixes tobacco with cannabis and does mixing relate to nicotine dependence?. Addictive behaviors, 128, 107254. https://doi.org/10.1016/j.addbeh.2022.107254
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