College students who co-used tobacco and marijuana were more ready to quit cigarettes than marijuana, with distinct factors predicting each | Research

The takeaway

A study of 721 college substance users found that tobacco-marijuana co-users rated quitting importance higher for cigarettes than marijuana but had lower quitting confidence for cigarettes, and were more likely to report readiness and actual quit attempts for cigarettes versus marijuana.

Cessation program developers; college health professionals; researchers studying polysubstance use in young adults.

Co-users rated quitting importance higher for cigarettes but had lower confidence in quitting them

What the researchers found

Researchers studied 721 college students aged 18-25 who used cigarettes and/or marijuana: 238 cigarette-only, 331 marijuana-only, and 152 co-users.

Co-users rated the importance of quitting higher for cigarettes than marijuana, but had lower confidence in their ability to quit cigarettes versus marijuana.

Co-users were more likely to report readiness to quit cigarettes (vs. marijuana) and more likely to have made recent quit attempts for cigarettes (vs. marijuana).

Among single-product users: 41.18% of cigarette-only users reported recent quit attempts vs. 21.75% of marijuana-only users. Readiness to quit was 15.13% for cigarette-only and 23.26% for marijuana-only users.

Correlates of co-use (vs. single use) included attending public/technical colleges (vs. private), using little cigars/cigarillos, using e-cigarettes, and alcohol use.

The factors predicting readiness to quit and actual quit attempts differed for cigarettes versus marijuana, suggesting cessation programs need product-specific approaches.

Why it matters

The finding that co-users prioritize quitting cigarettes over marijuana has implications for cessation programs. Co-users may benefit from sequential approaches that leverage their motivation to quit tobacco while addressing marijuana use as a related but distinct behavior.

The numbers in context

721 users: 238 cigarette-only, 331 marijuana-only, 152 co-users. Importance rated higher for quitting cigarettes vs marijuana (p<0.001). Confidence rated lower for quitting cigarettes vs marijuana (p<0.001). 41.18% of cigarette-only users had recent quit attempts vs 21.75% of marijuana-only users.

How the study worked

Cross-sectional study of 721 college students aged 18-25 from seven Georgia campuses. Multinomial logistic regression for user group correlates. Binary logistic regression for cessation outcomes.

What this study cannot tell us

Cross-sectional design from seven Georgia campuses. Self-reported substance use. College student sample limits generalizability to non-college young adults. Co-use defined broadly without dose-response data.

How to read the evidence

Moderate. Multi-campus study with appropriate statistical methods, but cross-sectional design and regional sample limit generalizability.

When this study was published

Published in 2018. The landscape of tobacco and marijuana use among young adults continues to evolve with vaping and legalization changes.

The bigger picture

With many young adults using both tobacco and marijuana, cessation programs that address only one product may miss opportunities. Understanding the different motivations and barriers for each product can inform more effective interventions.

Questions still open

Does successfully quitting one substance affect the likelihood of quitting the other? Should cessation programs address both products simultaneously or sequentially? Why is quitting confidence lower for cigarettes than marijuana despite higher motivation?

Common questions

Why are co-users more motivated to quit cigarettes than marijuana?

Several factors may explain this: cigarette smoking carries greater social stigma than marijuana use in college populations, tobacco health risks are more widely known, and marijuana may be perceived as more recreational and less harmful. Co-users may see marijuana as something they choose to do and cigarettes as an addiction they want to escape.

Does quitting one affect the other?

This cross-sectional study could not answer that directly, but the finding that different factors predict quitting each substance suggests they may require separate cessation strategies. Addressing co-use is important because using one substance can trigger use of the other.

Read the original research

Psychosocial and cessation-related differences between tobacco-marijuana co-users and single product users in a college student population.

Addictive behaviors, 77, 21-27

View on PubMed ↗Publisher’s paper ↗

Citation

Masters, Matthew N; Haardörfer, Regine; Windle, Michael; Berg, Carla. (2018). Psychosocial and cessation-related differences between tobacco-marijuana co-users and single product users in a college student population.. Addictive behaviors, 77, 21-27. https://doi.org/10.1016/j.addbeh.2017.09.007