Among US adults who had used marijuana, regular marijuana smoking with tobacco doubled the odds of reporting poor health, and regular marijuana alone still increased odds by 34%, compared to non-regular users without tobacco.
Readers who use marijuana regularly, especially with tobacco.
Regular marijuana + tobacco: 98% higher odds of poor self-rated health vs. non-regular/no-tobacco
What the researchers found
Using nationally representative NHANES data (2009-2012) from 3,210 adults who had used marijuana at least once, researchers examined how patterns of marijuana and tobacco co-use related to self-rated health.
Among ever marijuana users, 24.7% were regular marijuana smokers who also currently used tobacco, 21.1% were regular marijuana smokers without tobacco, and 15.2% were non-regular marijuana smokers with tobacco.
Compared to non-regular marijuana users without tobacco (the reference group), the adjusted prevalence ratios for reporting "fair" or "poor" health were: regular marijuana + tobacco: 1.98 (nearly double the odds), non-regular marijuana + tobacco: 1.82, and regular marijuana without tobacco: 1.34.
Tobacco use was the dominant driver of worse self-rated health, but regular marijuana use alone was also significantly associated with suboptimal health status.
Why it matters
This study separates the effects of marijuana and tobacco, which are commonly used together. The finding that regular marijuana use alone (without tobacco) was still associated with worse self-rated health challenges the narrative that marijuana is entirely benign. However, the effect was much smaller than tobacco's contribution.
The numbers in context
3,210 NHANES respondents. Regular marijuana + tobacco: aPR 1.98 (CI 1.50-2.61). Non-regular marijuana + tobacco: aPR 1.82 (CI 1.40-2.37). Regular marijuana without tobacco: aPR 1.34 (CI 1.05-1.69). Tobacco verified by cotinine ≥3.08 ng/mL.
How the study worked
Cross-sectional analysis of NHANES 2009-2012 data. Tobacco use verified by serum cotinine levels (not self-report). Regular marijuana use defined as at least once monthly for more than one year. Multivariable log-linear regression controlled for demographics and other covariates.
What this study cannot tell us
Cross-sectional design cannot determine causation. Self-rated health is subjective and influenced by many factors. The association between regular marijuana use and poor self-rated health could reflect confounding by other health behaviors, socioeconomic factors, or the conditions that lead people to use marijuana. Regular use was defined as monthly for a year, which encompasses a wide range of consumption patterns.
How to read the evidence
Moderate evidence from nationally representative survey data with objective tobacco verification.
When this study was published
Published in 2017, using 2009-2012 NHANES data.
The bigger picture
The marijuana-tobacco co-use pattern is the norm, not the exception: among regular marijuana users, nearly half also use tobacco. Disentangling the health effects of each substance is critical for public health messaging. This study suggests that while tobacco is the larger health concern, regular marijuana use has its own independent association with worse perceived health.
Questions still open
- Is the marijuana-health association due to smoking or cannabis itself? Would non-smoking consumption methods show the same pattern? Does self-rated health capture actual clinical outcomes or broader psychosocial factors?
Common questions
Is marijuana bad for your health even without tobacco?
Which is worse for health, marijuana or tobacco?
Read the original research
Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana.
Preventive medicine reports, 6, 251-257
Citation
Tsai, James; Rolle, Italia V; Singh, Tushar; Boulet, Sheree L; McAfee, Timothy A; Grant, Althea M. (2017). Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana.. Preventive medicine reports, 6, 251-257. https://doi.org/10.1016/j.pmedr.2017.03.014
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