Mississippi high schoolers who use cannabis are also more likely to vape, drink, and smoke tobacco

In multivariable analysis adjusting for gender, race, grade, and other risk behaviors, cannabis use was significantly associated with current electronic vaping, current tobacco smoking, current alcohol drinking, and sexual behaviors. Univariate analysis also identified associations with carrying weapons on campus, suicidal attempts, and unsupervised time, but these lost significance after adjustment.

Cross-sectional analysis of 2021 Mississippi Youth Risk Behavior Surveillance System (YRBS) data using survey-weighted logistic regression to examine associations between current cannabis use and other risk behaviors among high school students.

Cannabis rarely occurs in isolation among high schoolers. The clustering of cannabis with vaping, alcohol, tobacco, and sexual risk behaviors suggests prevention programs need to address multiple substances simultaneously rather than targeting cannabis alone.

The finding that cannabis use does not vary by gender or race in Mississippi challenges stereotypes about who uses cannabis. The clustering of risk behaviors supports integrated prevention approaches rather than substance-specific programs.

Cross-sectional YRBS data cannot determine temporal ordering or causation. Self-reported behaviors in a school setting may underreport. Mississippi-specific findings may not generalize to other states. 2021 data may not reflect current patterns.