8% of Americans Co-Use Tobacco and Cannabis — Here's How They Do It
The first nationally representative estimate finds 8.2% of Americans co-use tobacco and cannabis, with combustible-combustible being the most common combination for adults and nicotine vaping most common for youth.
Quick Facts
What This Study Found
8.2% of U.S. youth and adults reported current (past 30-day) co-use. Combustible tobacco + combustible cannabis was the most common form, accounting for nearly one-third of co-users. Among ages 12-24, co-use involving nicotine vaping was most common. Among 25+, combustible-combustible dominated. Use of multiple administration routes was also common.
Key Numbers
39,947 participants. 8.2% current co-users. Combustible-combustible: ~1/3 of co-users (most common overall). Ages 25-39 and 40+: combustible methods dominate. Ages 12-24: nicotine vaping most common in co-use. Multiple routes common among co-users.
How They Did This
Analysis of Wave 7 (2022/2023) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study (N=39,947). Weighted to produce representative estimates. Examined specific routes of administration for both tobacco and cannabis among co-users by age group.
Why This Research Matters
Co-use of tobacco and cannabis compounds health risks (as shown by RTHC-08179), and understanding how people combine these substances is essential for prevention. The age-based differences in administration routes suggest different intervention approaches are needed for different generations.
The Bigger Picture
The generational shift from combustible to vaping co-use has important health implications. While vaping may reduce some combustion-related harms, the emergence of dual-vaping (nicotine + cannabis) in young people creates new exposure patterns with unknown long-term effects.
What This Study Doesn't Tell Us
Self-reported use. Past 30-day window doesn't capture same-session co-use. Rapidly evolving product landscape may make these estimates outdated quickly. Route categories may not capture all product types (e.g., cigarillos/blunts bridge tobacco-cannabis categories).
Questions This Raises
- ?Does the shift from combustible to vaping co-use reduce health harms?
- ?Should prevention address co-use specifically or each substance separately?
- ?How will emerging products (cannabis + nicotine vapes) change co-use patterns?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large nationally representative survey (PATH Study) with detailed product-level data — the gold standard for prevalence estimation.
- Study Age:
- Published in 2026, using 2022/2023 PATH data providing the most current co-use estimates available.
- Original Title:
- Tobacco and cannabis co-use by route of administration in the United States, 2022/2023.
- Published In:
- Addictive behaviors, 175, 108595 (2026)
- Authors:
- Gibson, Laurel P(5), Parks, Michael J, Kimmel, Heather L, Blanco, Carlos, Ciccolo, Joseph T, Creamer, MeLisa R, Everard, Colm, Freedman, Neal D, Garcia, Melissa, Kingsbury, John H, Lee, Youn Ok, Marshall, Daniela, Compton, Wilson M, Kaufman, Annette
- Database ID:
- RTHC-08277
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
How common is using both tobacco and cannabis?
About 8.2% of Americans (youth and adults) reported using both in the past month — roughly 1 in 12 people. The most common combination was smoking both substances, but younger users increasingly combine nicotine vaping with cannabis.
Does the way people co-use matter for health?
Yes — the shift from combustible to vaping among youth creates different exposure profiles with different potential risks. Also, using multiple administration routes for either substance was common, complicating health risk assessment.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08277APA
Gibson, Laurel P; Parks, Michael J; Kimmel, Heather L; Blanco, Carlos; Ciccolo, Joseph T; Creamer, MeLisa R; Everard, Colm; Freedman, Neal D; Garcia, Melissa; Kingsbury, John H; Lee, Youn Ok; Marshall, Daniela; Compton, Wilson M; Kaufman, Annette. (2026). Tobacco and cannabis co-use by route of administration in the United States, 2022/2023.. Addictive behaviors, 175, 108595. https://doi.org/10.1016/j.addbeh.2026.108595
MLA
Gibson, Laurel P, et al. "Tobacco and cannabis co-use by route of administration in the United States, 2022/2023.." Addictive behaviors, 2026. https://doi.org/10.1016/j.addbeh.2026.108595
RethinkTHC
RethinkTHC Research Database. "Tobacco and cannabis co-use by route of administration in th..." RTHC-08277. Retrieved from https://rethinkthc.com/research/gibson-2026-tobacco-and-cannabis-couse
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.