Young Adults Who Smoked Both Cigarettes and Marijuana Had Linked Use Patterns but Different Quit Motivations | Research

The takeaway

Among young adults who used both cigarettes and marijuana, use frequency and dependence were correlated across the two substances, but motivation to quit cigarettes was higher than motivation to quit marijuana.

Read this if you use both cigarettes and marijuana and are thinking about quitting one or both.

49% of young adult cigarette smokers also used marijuana in the past month

What the researchers found

Of 1,987 young adult cigarette smokers surveyed, nearly half (972) also reported past-month marijuana use. Among these dual users, frequency of use, temptation to use, measures of dependence, decisional balance (pros and cons), and past-year quit attempts were all significantly correlated between cigarettes and marijuana.

However, motivation to quit was not correlated across substances. Participants reported greater desire and more advanced stages of change for quitting cigarettes compared to marijuana. They were more likely to endorse a cigarette abstinence goal. Paradoxically, they had lower confidence in their ability to quit and stay quit from cigarettes compared to marijuana.

This pattern suggests young adults view cigarettes as more problematic and are more open to quitting tobacco, even though they expect it to be harder.

Why it matters

The high rate of co-use among young adults means treatment programs need to consider both substances. The finding that motivation differs across substances suggests intervention approaches may need to be tailored: young adults may be more receptive to tobacco cessation messaging while viewing marijuana use as less problematic.

The numbers in context

972 of 1,987 young adult smokers (49%) also used marijuana. 68% male, 71% Caucasian, mean age 20.4. Use frequency, dependence, and quit attempts were correlated across substances (all p<0.05). Motivation to quit was not correlated.

How the study worked

Young adults aged 18-25 who had smoked at least one cigarette in the past 30 days completed an anonymous online survey. Of 1,987 respondents, 972 reported both past-month cigarette and marijuana use. Measures included frequency and severity of use, temptations, dependence, decisional balance, stage of change, quit attempts, and abstinence expectations for each substance.

What this study cannot tell us

This was a cross-sectional online survey, subject to self-selection bias. The sample skewed male and Caucasian. Self-reported substance use may be inaccurate. The survey recruited cigarette smokers, so it cannot generalize to all young adult marijuana users. Causal relationships between cigarette and marijuana use patterns cannot be determined.

How to read the evidence

This is a cross-sectional online survey. It provides useful descriptive data but cannot establish causal relationships.

When this study was published

Published in 2014. Co-use patterns may have shifted as marijuana legalization has expanded since.

The bigger picture

As marijuana legalization expands, co-use of tobacco and cannabis is likely to remain common. Understanding how young adults think about each substance differently, despite using them in correlated patterns, is essential for designing effective dual-use interventions.

Questions still open

Would quitting one substance facilitate quitting the other? Should cessation interventions address both substances simultaneously or sequentially? Does the pattern of higher cigarette quit motivation persist as marijuana becomes more normalized?

Common questions

Why were young adults more motivated to quit cigarettes than marijuana?

Decades of public health messaging have established cigarettes as harmful. Marijuana may be perceived as less risky, more socially acceptable among young adults, or more tied to recreational contexts that users do not want to give up.

Does quitting one substance help with quitting the other?

This study did not answer that directly. Some research suggests that co-use makes quitting either substance harder, while other studies suggest that addressing tobacco first can improve overall substance use outcomes.

Read the original research

Young adults who smoke cigarettes and marijuana: analysis of thoughts and behaviors.

Addictive behaviors, 39(1), 77-84

View on PubMed ↗Publisher’s paper ↗

Citation

Ramo, Danielle E; Delucchi, Kevin L; Liu, Howard; Hall, Sharon M; Prochaska, Judith J. (2014). Young adults who smoke cigarettes and marijuana: analysis of thoughts and behaviors.. Addictive behaviors, 39(1), 77-84. https://doi.org/10.1016/j.addbeh.2013.08.035