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Fairman BJ, Kimmel HL, Blanco C, Compton WM. Blunt and non-blunt cannabis use associated with cigarette, e-cigarette, and cigar initiation: Findings from the population assessment of tobacco and health (PATH) study. Drug Alcohol Depend 2023; 246:109837. [PMID: 36931132 PMCID: PMC10161973 DOI: 10.1016/j.drugalcdep.2023.109837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Smoking cannabis using a tobacco-derived cigar shell or wrap, called blunt smoking, exposes individuals to non-trivial amounts of nicotine. The extent smoking blunts impact the risk of initiating other tobacco products is not well understood. We investigated if past-year blunt smoking is related to the risk of initiating cigarettes, e-cigarettes, and cigars. METHODS We obtained data on a nationally representative, non-institutionalized, civilian cohort of US residents aged 12 years and older who had never used cigarettes, e-cigarettes, or any cigar at baseline and surveyed annually for three years from the Population Assessment of Tobacco and Health Study. We estimated the proportional hazard (odds) of initiating these tobacco products associated with past-year blunt smoking, non-blunt cannabis use, or neither using discrete-time survival analyses. RESULTS Smoking blunts increased the risk of starting cigarettes (OR = 4.5), e-cigarettes (OR = 3.7), and cigars (OR = 6.7) compared to using neither blunts nor cannabis. Non-blunt cannabis use also increased the risk of starting cigarettes (OR = 4.0) but moderately for e-cigarettes (OR = 2.8) and any cigar (OR = 2.2). Blunt use was strongly related to starting combustible tobacco (cigarettes or cigars; OR = 9.0) and any three tobacco products (OR = 10.9). Exploratory findings showed that cigarillos drove cigar results and effect modification by age, race/ethnicity, and sex. CONCLUSIONS People who smoke blunts risk starting cigarettes, e-cigarettes, and cigars more than those who abstain from cannabis. Blunts may contribute to tobacco initiation above cannabis alone.
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Affiliation(s)
- Brian J Fairman
- Department of Epidemiology, University of Arkansas for Medical Sciences, United States.
| | - Heather L Kimmel
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Wilson M Compton
- Office of the Director, National Institute on Drug Abuse, National Institutes of Health, United States
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Nguyen N, Neilands TB, Lisha NE, Lyu JC, Olson SS, Ling PM. Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment. J Addict Med 2022; 16:413-419. [PMID: 34619713 PMCID: PMC8980109 DOI: 10.1097/adm.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Cannabis use is common among people who use tobacco. However, little is known about the relationship between change in use of tobacco and cannabis over time. We examined the longitudinal associations between use of the two substances in a realworld smoking cessation context. METHODS This study analyzed data from a 3-month smoking cessation program delivered via Facebook in the San Francisco Bay Area, USA during 2016-2020. The sample included 487 participants who smoked cigarettes ( Mage = 25.4 years old, 39.6% Male, 40.3% White). The regressors (ie, frequency or number of days during the past 30 days using cigarettes, e-cigarettes, and cigars) and the outcome (ie, frequency of cannabis use) were measured at both baseline and 3-month follow-up. Random-effects modeling examined the longitudinal associations between the regressors and the outcome controlling for alcohol use and baseline demographics. RESULTS Participants who increased (or decreased) their frequency of use of cigarettes (β = 0.17, 95% confidence interval [CI] = 0.10, 0.24), e-cigarettes (β = 0.11, 95% CI = 0.05, 0.17), or cigars (β = 0.19, 95% CI = 0.06, 0.32) also increased (or decreased) their frequency of cannabis use after 3 months. Sexual minority participants (vs heterosexuals) (β = 2.12, 95% CI = 0.01, 4.24) and those whose education attainment being high school or less (vs higher education) (β = 3.89, 95% CI = 1.25, 6.53) were more likely to increase their frequency of cannabis use over time. CONCLUSIONS The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.
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Affiliation(s)
- Nhung Nguyen
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA
| | - Nadra E. Lisha
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Joanne Chen Lyu
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Sarah S. Olson
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
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Page RL, Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, Piano MR, Rana JS, Saucedo JF. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e131-e152. [DOI: 10.1161/cir.0000000000000883] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cannabis, or marijuana, has potential therapeutic and medicinal properties related to multiple compounds, particularly Δ-9-tetrahydrocannabinol and cannabidiol. Over the past 25 years, attitudes toward cannabis have evolved rapidly, with expanding legalization of medical and recreational use at the state level in the United States and recreational use nationally in Canada and Uruguay. As a result, the consumption of cannabis products is increasing considerably, particularly among youth. Our understanding of the safety and efficacy of cannabis has been limited by decades of worldwide illegality and continues to be limited in the United States by the ongoing classification of cannabis as a Schedule 1 controlled substance. These shifts in cannabis use require clinicians to understand conflicting laws, health implications, and therapeutic possibilities. Cannabis may have therapeutic benefits, but few are cardiovascular in nature. Conversely, many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by mechanisms of delivery. This statement critically reviews the use of medicinal and recreational cannabis from a clinical but also a policy and public health perspective by evaluating its safety and efficacy profile, particularly in relationship to cardiovascular health.
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Bailey JA, Epstein M, Roscoe JN, Oesterle S, Kosterman R, Hill KG. Marijuana Legalization and Youth Marijuana, Alcohol, and Cigarette Use and Norms. Am J Prev Med 2020; 59:309-316. [PMID: 32654862 PMCID: PMC7483911 DOI: 10.1016/j.amepre.2020.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Rates of adolescent substance use have decreased in recent years. Knowing whether nonmedical marijuana legalization for adults is linked to increases or slows desirable decreases in marijuana and other drug use or pro-marijuana attitudes among teens is of critical interest to inform policy and promote public health. This study tests whether nonmedical marijuana legalization predicts a higher likelihood of teen marijuana, alcohol, or cigarette use or lower perceived harm from marijuana use in a longitudinal sample of youth aged 10-20 years. METHODS Data were drawn from the Seattle Social Development Project-The Intergenerational Project, an accelerated longitudinal study of youth followed both before (2002-2011) and after nonmedical marijuana legalization (2015-2018). Analyses included 281 youth surveyed up to 10 times and living in a state with nonmedical marijuana legalization between 2015 and 2018 (51% female; 33% white, 17% African American, 10% Asian/Pacific Islander, and 40% mixed race or other). RESULTS Multilevel modeling in 2019 showed that nonmedical marijuana legalization predicted a higher likelihood of self-reported past-year marijuana (AOR=6.85, p=0.001) and alcohol use (AOR 3.38, p=0.034) among youth when controlling birth cohort, sex, race, and parent education. Nonmedical marijuana legalization was not significantly related to past-year cigarette use (AOR=2.43, p=0.279) or low perceived harm from marijuana use (AOR=1.50, p=0.236) across youth aged 10-20 years. CONCLUSIONS It is important to consider recent broad declines in youth substance use when evaluating the impact of nonmedical marijuana legalization. States that legalize nonmedical marijuana for adults should increase resources for the prevention of underage marijuana and alcohol use.
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Affiliation(s)
- Jennifer A Bailey
- Social Development Research Group, University of Washington, Seattle, Washington.
| | - Marina Epstein
- Social Development Research Group, University of Washington, Seattle, Washington
| | - Joseph N Roscoe
- School of Social Welfare, University of California, Berkeley, California
| | - Sabrina Oesterle
- Social Development Research Group, University of Washington, Seattle, Washington
| | - Rick Kosterman
- Social Development Research Group, University of Washington, Seattle, Washington
| | - Karl G Hill
- Institute of Behavioral Science, University of Colorado, Boulder, Colorado
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Rogers AH, Shepherd JM, Buckner JD, Garey L, Manning K, Orr MF, Schmidt NB, Zvolensky MJ. Current cannabis use and smoking cessation among treatment seeking combustible smokers. Drug Alcohol Depend 2020; 209:107928. [PMID: 32092636 PMCID: PMC8802811 DOI: 10.1016/j.drugalcdep.2020.107928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Combustible tobacco smoking and cannabis use frequently occur together, and the use of both substances is associated with overall greater severity of tobacco and cannabis related problems. Observational work has found that cannabis use is associated with tobacco cessation failure, but research directly testing the longitudinal associations of cannabis use on tobacco cessation during smoking cessation treatment is lacking. The current study examined the impact of current cannabis use on combustible tobacco cessation outcomes. METHODS 207 daily combustible tobacco smokers (Mage = 38.24 years, SD = 14.84, 48.1 % male) were enrolled in a randomized controlled smoking cessation trial. Survival analyses and multi-level modeling were used to assess lapse and relapse behavior through 12-week follow up. The current study is a secondary data analysis. RESULTS Results of the current study suggest that cannabis use is associated with faster time to lapse (OR = 0.644, se = .188, p = .019), but not relapse (OR = -0.218, se = .403, p = .525), compared to combustible tobacco-only smokers. Additionally, cannabis use was associated with lower likelihood of achieving any 7-day point prevalence abstinence during the 12 week follow up (b = 0.93, se = 0 0.24, p = 0.0001). CONCLUSIONS The current study provides novel evidence that cannabis use may be related to combustible tobacco use in terms of faster time to lapse and lower likelihood of any 7-day point prevalence abstinence following smoking cessation treatment. Developing integrated cannabis-tobacco cessation treatments is an important next step in research focused on tobacco-cannabis use.
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Affiliation(s)
- Andrew H. Rogers
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Justin M. Shepherd
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Julia D. Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Kara Manning
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael F. Orr
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States.,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States.,HEALTH Institute, University of Houston, Houston, TX, United States
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Fataar F, Hammond D. The Prevalence of Vaping and Smoking as Modes of Delivery for Nicotine and Cannabis among Youth in Canada, England and the United States. Int J Environ Res Public Health 2019; 16:E4111. [PMID: 31731420 DOI: 10.3390/ijerph16214111] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 01/09/2023]
Abstract
Background: Vaping has become an increasingly common mode of administration for both nicotine and cannabis, with overlap among users, devices, as well as nicotine and cannabis companies. There is a need to understand patterns of use among youth, including the way nicotine and cannabis are administered. Methods: Data are from Wave 2 of the ITC Youth Tobacco and Vaping survey, an online survey conducted in 2018 among 16–19 year-olds recruited from commercial panels in Canada (n = 3757), England (n = 3819), and the U.S. (n = 3961). The prevalence of past 30-day vaping nicotine, non-nicotine and cannabis substances, as well as cannabis modes of use was examined. Logistic regression models examined between country differences in prevalence. Results: Past 30-day cannabis use was highest among Canadian youth (16.6%), followed by youth in the U.S. (13.8%) and England (9.0%). Vaping e-cigarettes was substantially more prevalent than vaping cannabis in all three countries. All forms of cannabis use were higher among Canadian and U.S. youth compared to England (p < 0.001 for all). Past 30-day cannabis users in the U.S. were more likely to report vaping cannabis oil (30.1%), and consuming solid concentrates such as wax and shatter (30.2%), compared to cannabis users in Canada (18.6% and 22.9%) and England (14.3% and 11.0%; p < 0.001 for all). Conclusions: Youth are administering cannabis and nicotine using a wide diversity of modes. Cannabis users in the U.S.—where an increasing number of states have legalized medical and non-medical cannabis—reported notably higher use of more potent cannabis products, including cannabis oils and extracts.
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Nguyen TQ, Ebnesajjad C, Stuart EA, Kennedy RD, Johnson RM. Does Marijuana Use at Ages 16-18 Predict Initiation of Daily Cigarette Smoking in Late Adolescence and Early Adulthood? A Propensity Score Analysis of Add Health Data. Prev Sci 2019; 20:246-256. [PMID: 29388049 PMCID: PMC8100978 DOI: 10.1007/s11121-018-0874-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the declining trend in adolescent cigarette smoking and increase in general access to marijuana, it is important to examine whether marijuana use in adolescence is a risk factor for subsequent cigarette smoking in late adolescence and early adulthood. Preliminary evidence from a very small number of studies suggests that marijuana use during adolescence is associated with later smoking; however, to control confounding, previously published studies used regression adjustment, which is susceptible to extrapolation when the confounder distributions differ between adolescent marijuana users and non-users. The current study uses propensity score weighting, a causal inference method not previously used in this area of research, to weight participants based on their estimated probability of exposure given confounders (the propensity score) to balance observed confounders between marijuana users and non-users. The sample consists of participants of Add Health (a nationally representative dataset of youth followed into adulthood) who were 16-18, with no history of daily cigarette smoking at baseline (n = 2928 for female and 2731 for male sub-samples). We assessed the effect of adolescent marijuana use (exposure, ascertained at wave 1) on any daily cigarette smoking during the subsequent 13 years (outcome, ascertained at wave 4). Analyses suggest that for females (but not males) who used marijuana in adolescence, marijuana use increased the risk for subsequent daily smoking: OR = 1.71, 95% CI = (1.13, 2.59). We recommend that adolescent marijuana use be viewed as a possible risk factor for subsequent initiation of daily cigarette smoking in women.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Cyrus Ebnesajjad
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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