Same-Day Nicotine and Cannabis Use Linked to Higher Dependence Symptoms in Teens
Adolescents who used nicotine and cannabis on the same day had over 4 times the odds of cannabis dependence symptoms compared to those who used both but on different days.
Quick Facts
What This Study Found
Among 3,823 Southern California high school students, 3.3% reported same-day nicotine-cannabis co-use. Same-day co-users had 4.28 times the odds of cannabis dependence symptoms (95% CI: 1.98-9.28) compared to those who used both substances in the same month but not on the same day. Odds of nicotine dependence were also elevated (aOR=1.81) but not statistically significant.
Key Numbers
3,823 students. 3.3% same-day co-use, 1.5% past-month co-use, 1.6% exclusive nicotine, 3.1% exclusive cannabis, 90.5% no use. Same-day vs past-month co-use: cannabis dependence aOR=4.28 (95% CI: 1.98-9.28). Nicotine dependence aOR=1.81 (95% CI: 0.87-3.77, NS).
How They Did This
Cross-sectional survey of 3,823 Southern California high school students in Fall 2022. Five mutually exclusive past-month use groups. Adjusted logistic regression models for nicotine and cannabis dependence symptoms.
Why This Research Matters
This study demonstrates that how researchers measure co-use matters. Same-day co-use appears to be a marker of more problematic behavior than simply using both substances within the same month.
The Bigger Picture
Combined with the adult finding that simultaneous alcohol-cannabis use is riskier than concurrent use (RTHC-06681), this study reinforces that the temporal pattern of substance co-use is a critical but often overlooked dimension of risk.
What This Study Doesn't Tell Us
Cross-sectional design. Southern California sample may not generalize. Self-reported use and dependence symptoms. Small absolute numbers in co-use groups limit statistical power. Cannot determine if same-day use causes dependence or if more dependent users are more likely to co-use.
Questions This Raises
- ?Does same-day co-use cause more dependence, or do more dependent teens simply use more substances on any given day?
- ?Would interventions targeting same-day co-use specifically reduce dependence trajectories?
Trust & Context
- Key Stat:
- Same-day nicotine-cannabis use was associated with 4.28x higher odds of cannabis dependence symptoms
- Evidence Grade:
- Reasonable sample with precise co-use measurement, but cross-sectional design and regional sample limit causal inference.
- Study Age:
- 2025 publication with Fall 2022 data.
- Original Title:
- Assessment of nicotine and cannabis co-use among adolescents and the association with nicotine and cannabis dependence symptoms.
- Published In:
- Addictive behaviors, 171, 108471 (2025)
- Authors:
- Jafarzadeh, Nikki S(2), Harlow, Alyssa F(7), Walsh, Claire A(2), Whaley, Reid C, Han, Dae-Hee, Leventhal, Adam M, Barrington-Trimis, Jessica L
- Database ID:
- RTHC-06728
Evidence Hierarchy
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06728APA
Jafarzadeh, Nikki S; Harlow, Alyssa F; Walsh, Claire A; Whaley, Reid C; Han, Dae-Hee; Leventhal, Adam M; Barrington-Trimis, Jessica L. (2025). Assessment of nicotine and cannabis co-use among adolescents and the association with nicotine and cannabis dependence symptoms.. Addictive behaviors, 171, 108471. https://doi.org/10.1016/j.addbeh.2025.108471
MLA
Jafarzadeh, Nikki S, et al. "Assessment of nicotine and cannabis co-use among adolescents and the association with nicotine and cannabis dependence symptoms.." Addictive behaviors, 2025. https://doi.org/10.1016/j.addbeh.2025.108471
RethinkTHC
RethinkTHC Research Database. "Assessment of nicotine and cannabis co-use among adolescents..." RTHC-06728. Retrieved from https://rethinkthc.com/research/jafarzadeh-2025-assessment-of-nicotine-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.