Nearly half of current cigarette smokers in high-tobacco states also use cannabis, averaging 19 days per month | Research

The takeaway

A survey of 9,100 adults in 13 high-tobacco-burden states found 8.7% co-use prevalence, with 45% of current cigarette smokers also using cannabis about 19 days per month, and co-use most common among young, male, Black, and disabled individuals.

Tobacco cessation programs, public health officials in high-burden states, dual-use researchers

45% of current cigarette smokers in high-tobacco states also used cannabis

What the researchers found

45% of current cigarette smokers reported concurrent cannabis use, compared to 24.5% of former smokers and 12.3% of never smokers. Co-users smoked 12.8 cigarettes per day and used cannabis 18.9 days per month, similar to exclusive users of either substance. Co-use was more likely among males, those aged 18-24, non-Hispanic Black individuals, single individuals, and those with mental or physical disabilities.

Why it matters

Cannabis and tobacco co-use may produce additive health risks, particularly for respiratory health. In states already struggling with high tobacco use, cannabis co-use adds another layer of concern that tobacco control efforts need to address.

The numbers in context

9,100 adults; 13 high-tobacco-burden states; 8.7% co-use prevalence; 45.0% of current smokers used cannabis; 24.5% of former smokers; 12.3% of never smokers; co-users: 12.8 cigarettes/day, 18.9 cannabis days/month; higher among males, ages 18-24, non-Hispanic Black, single, with disabilities

How the study worked

Online rapid-response survey of a probability sample of 9,100 adults aged 18-65 in 13 high-tobacco-burden states, collected 2023-2024. Weighted prevalence calculations and logistic regressions examined sociodemographic correlates and patterns of co-use.

What this study cannot tell us

Cross-sectional design in 13 high-tobacco states may not generalize to all states. Online survey may miss some populations. Self-reported use subject to bias. Cannot determine whether co-use leads to worse health outcomes than exclusive use.

How to read the evidence

Moderate: probability-sampled survey with appropriate weighting and regression methods, but limited to 13 high-tobacco states and cross-sectional design.

When this study was published

2026 publication from 2023-2024 survey in 13 high-tobacco-burden states.

The bigger picture

This highlights that cannabis use does not replace tobacco but often accompanies it, especially in populations already at high risk. Tobacco control programs in these states need to account for dual use rather than treating each substance in isolation.

Questions still open

Does cannabis co-use make quitting cigarettes harder or easier? Are the respiratory effects of dual use additive or synergistic? Would integrated cessation programs addressing both substances be more effective than single-substance approaches?

Common questions

How common is using both cannabis and cigarettes?

In 13 high-tobacco-burden states, 8.7% of adults used both. Among current cigarette smokers specifically, 45% also used cannabis.

Who is most likely to use both?

Co-use was more common among males, younger adults (18-24), non-Hispanic Black individuals, single individuals, and those with mental or physical disabilities.

Read the original research

Prevalence, Patterns, and Correlates of Cannabis-Cigarette Co-Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023-2024.

American journal of preventive medicine, 70(2S), 108114

View on PubMed ↗Publisher’s paper ↗

Citation

Xue, Zheng; Gibson, Laurel P; Nighbor, Tyler; Nargis, Nigar; Westmaas, J Lee; Patel, Minal. (2026). Prevalence, Patterns, and Correlates of Cannabis-Cigarette Co-Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023-2024.. American journal of preventive medicine, 70(2S), 108114. https://doi.org/10.1016/j.amepre.2025.108114