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

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.

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.

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.

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.

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.