Adults With HIV Are 3.35 Times More Likely to Co-use Tobacco and Cannabis
Analysis of 139,524 US adults found those with HIV were 3.35 times more likely to co-use tobacco and cannabis, with the association modified by race/ethnicity and state-level medical cannabis laws.
Quick Facts
What This Study Found
Adults with HIV had 3.35x higher odds of past-month tobacco-cannabis co-use (aRRR=3.35, 95% CI: 1.79-6.27). 0.4% of respondents reported HIV; 8.2% reported tobacco-cannabis co-use. Race/ethnicity and state medical cannabis legalization modified the HIV-co-use association.
Key Numbers
139,524 adults; 0.4% HIV+; 8.2% co-use; aRRR=3.35 for HIV and co-use; race/ethnicity and state laws modified association.
How They Did This
Cross-sectional analysis of 2021-2023 National Survey on Drug Use and Health. 139,524 adult respondents. Adjusted multinomial logistic regression with interaction testing for demographics and state cannabis laws.
Why This Research Matters
Tobacco-cannabis co-use poses unique health risks including lung disease, drug dependence, and potential ART interactions. The high co-use rate among PWH demands targeted harm reduction strategies.
The Bigger Picture
As HIV becomes a chronic condition and cannabis legalizes, the intersection of HIV, tobacco, and cannabis creates complex clinical scenarios that most providers are not trained to address.
What This Study Doesn't Tell Us
Cross-sectional design. Self-reported HIV diagnosis may undercount. Cannot determine temporal order. NSDUH household survey may miss homeless/institutionalized populations.
Questions This Raises
- ?Should HIV care routinely screen for tobacco-cannabis co-use?
- ?Does medical cannabis legalization encourage or reduce harmful co-use patterns among PWH?
Trust & Context
- Key Stat:
- 3.35x higher odds of tobacco-cannabis co-use among adults with HIV
- Evidence Grade:
- Very large nationally representative sample with detailed subgroup analysis. Cross-sectional design limits causal inference.
- Study Age:
- 2025 analysis of 2021-2023 NSDUH data.
- Original Title:
- Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.
- Published In:
- AIDS and behavior, 29(12), 3794-3805 (2025)
- Authors:
- Lee, Juhan(3), Yin, Ana Paula Xingru, Weinberger, Andrea H(7)
- Database ID:
- RTHC-06909
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Do people with HIV use more cannabis and tobacco together?
Yes. Adults with HIV were 3.35 times more likely to co-use tobacco and cannabis compared to those without HIV.
Does state cannabis law matter?
Yes. State-level medical cannabis legalization status modified the association between HIV and tobacco-cannabis co-use.
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Cite This Study
https://rethinkthc.com/research/RTHC-06909APA
Lee, Juhan; Yin, Ana Paula Xingru; Weinberger, Andrea H. (2025). Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.. AIDS and behavior, 29(12), 3794-3805. https://doi.org/10.1007/s10461-025-04817-5
MLA
Lee, Juhan, et al. "Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.." AIDS and behavior, 2025. https://doi.org/10.1007/s10461-025-04817-5
RethinkTHC
RethinkTHC Research Database. "Tobacco and Cannabis Co-use by HIV Status Among United State..." RTHC-06909. Retrieved from https://rethinkthc.com/research/lee-2025-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.