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.
Public health professionals, tobacco and cannabis researchers, prevention specialists, and anyone who uses both substances.
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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 Rapidly evolving product landscape may make these estimates outdated quickly.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).
How to read the evidence
Large nationally representative survey (PATH Study) with detailed product-level data — the gold standard for prevalence estimation.
When this study was published
Published in 2026, using 2022/2023 PATH data providing the most current co-use estimates available.
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.
Questions still open
- 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?
Common questions
How common is using both tobacco and cannabis?
Does the way people co-use matter for health?
Read the original research
Tobacco and cannabis co-use by route of administration in the United States, 2022/2023.
Addictive behaviors, 175, 108595
Citation
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