More than half of U.S. young adults who use cannabis employ two or more consumption methods, with recreational legalization, e-cigarette co-use, and frequent cannabis use among the strongest predictors.
Public health researchers, cannabis policy analysts, harm reduction advocates
57% of young adult cannabis users use multiple methods
What the researchers found
Among 7,635 young adults (18-34) reporting current cannabis use across 23 states, 57% used multiple modes (smoking, vaping, edibles, dabbing, etc.). Dual and triple-mode use were most common. Predictors of multi-modal use included recreational legalization, sexual minority status, poor physical health, frequent cannabis use, and co-use of e-cigarettes and alcohol.
Why it matters
Most cannabis research treats use as a binary (yes/no), but multi-modal use means different absorption rates, different health risks, and potentially different addiction profiles. Understanding that most young adult users are combining methods changes how we assess exposure.
The numbers in context
n = 7,635 (weighted 7.48 million); 57% multi-modal users; dual and triple-mode most common; recreational legalization significantly associated with multi-modal use.
How the study worked
Cross-sectional analysis of 2022-2023 BRFSS data from 23 states (weighted n = 7,482,134). Multi-modal use defined as two or more administration methods in the past month. Logistic regression for predictors.
What this study cannot tell us
BRFSS is self-reported via telephone. Multi-modal use definition (2+ methods in past month) does not capture frequency of each mode. Only 23 states participated in the cannabis module. Cross-sectional design.
How to read the evidence
Large nationally representative survey with weighted estimates, though limited by self-report and cross-sectional design.
When this study was published
2025 publication with 2022-2023 BRFSS data
The bigger picture
As product diversity increases in legal markets (flower, concentrates, edibles, vapes, topicals), single-mode use may become the minority. Public health surveillance and harm reduction messaging need to account for this complexity.
Questions still open
- Does multi-modal use increase total cannabis exposure or harm compared to single-mode use?
- Which specific combinations of consumption methods carry the highest health risks?
Common questions
How do young adults use cannabis?
Does cannabis legalization change how people consume it?
Read the original research
Multi-Modal Cannabis Use Among U.S. Young Adults: Findings from the 2022 and 2023 BRFSS in 23 States.
International journal of environmental research and public health, 22(4)
Citation
Kim, Nayoung; Flora, Sarah; Macander, Casey Elizabeth. (2025). Multi-Modal Cannabis Use Among U.S. Young Adults: Findings from the 2022 and 2023 BRFSS in 23 States.. International journal of environmental research and public health, 22(4). https://doi.org/10.3390/ijerph22040495