Nearly half of adult smokers in primary care also used cannabis or e-cigarettes | Research

The takeaway

Among 601 adult cigarette smokers in primary care, over half also used cannabis, e-cigarettes, or both, but cessation counseling did not consistently account for poly-use.

Primary care providers counseling smokers, tobacco cessation specialists, and public health researchers studying poly-substance use patterns.

51.4% of smokers also used cannabis, e-cigarettes, or both

What the researchers found

48.6% smoked cigarettes only. 30.4% also used cannabis. 10.5% also used e-cigarettes. 10.5% used all three products. Smoking behavior and motivation to quit did not differ between groups, but dual cigarette-e-cigarette users were more likely to receive complete cessation counseling.

Why it matters

Treating cigarette smoking without addressing concurrent cannabis or e-cigarette use may undermine cessation efforts. This study highlights how common poly-use is among smokers seeking primary care.

The numbers in context

601 smokers studied. 48.6% cigarette-only. 30.4% cigarette + cannabis. 10.5% cigarette + e-cigarette. 10.5% all three. Mean age 50.8, 38.1% female.

How the study worked

Cross-sectional secondary analysis from a smoking cessation trial in 3 diverse primary care clinics in San Francisco (2014-2015). 601 current cigarette smokers reported on past 30-day cigarette and e-cigarette use and past 3-month cannabis use.

What this study cannot tell us

Cross-sectional design from a single city (San Francisco) between 2014-2015. Self-reported substance use may undercount actual use. Cannabis and e-cigarette markets have changed significantly since data collection.

How to read the evidence

Secondary analysis from a clinical trial in a single city. Useful prevalence data but limited generalizability.

When this study was published

2020 publication using 2014-2015 data. Cannabis and e-cigarette use patterns may have shifted since data collection.

The bigger picture

Smoking cessation programs have traditionally focused on cigarettes alone. As cannabis and e-cigarette use become more common, providers need screening tools and guidelines that address multiple products simultaneously.

Questions still open

Does concurrent cannabis use reduce the likelihood of successful cigarette cessation? How should cessation counseling be adapted for poly-users? Have these patterns changed since cannabis legalization in California?

Common questions

Were poly-users less motivated to quit smoking?

No. Smoking behavior and motivation to quit did not significantly differ between cigarette-only smokers and those who also used cannabis or e-cigarettes.

Did providers counsel poly-users differently?

Dual cigarette-e-cigarette users were more likely to receive all five cessation counseling steps (5As), but cannabis co-users were not counseled differently from cigarette-only smokers.

Read the original research

Patterns of cigarette, e-cigarette, and cannabis use among adult smokers in primary care 2014-2015.

Addictive behaviors, 100, 106109

View on PubMed ↗Publisher’s paper ↗

Citation

Thrul, Johannes; Vijayaraghavan, Maya; Kalkhoran, Sara; Satterfield, Jason M. (2020). Patterns of cigarette, e-cigarette, and cannabis use among adult smokers in primary care 2014-2015.. Addictive behaviors, 100, 106109. https://doi.org/10.1016/j.addbeh.2019.106109