PATH to understanding cannabis and nicotine initiation and co-use among emerging adults

Objectives The purpose of this study was to describe the characteristics and age of initiation of nicotine and cannabis use, with a particular focus on the emerging adult period (ages 18-24 years) and concurrent use of nicotine with cannabis. Design A secondary analysis of Population Assessment of Tobacco and Health (PATH). Sample 32,078 participants from a nationally representative study of tobacco use and health outcomes. Measurement Variables of interest included ever use, regular use and age of initiation (first-time use) of nicotine (including tobacco) and/or cannabis and selected demographic factors. Results Ever-use of nicotine was associated with a 13-fold increase in the likelihood of having ever used cannabis. Among those who reported cannabis use, 96.4% had also used nicotine. While initiation in adolescence was most common, 27.1% of those who use nicotine and 34.9% of those who use cannabis initiated during emerging adulthood. Among regular users of nicotine, 41.5% began regular use in emerging adulthood. Conclusions These findings underscore the continued susceptibility of emerging adults to initiation of these substances. Co-use of nicotine and cannabis is an understudied phenomenon in emerging adults with significant potential to cause harm and should be a public health priority.

Automated summary

This study aimed to describe the characteristics and age of initiation of nicotine and cannabis use, with a focus on the emerging adult period and concurrent use of nicotine with cannabis. The results showed a significant increase in the likelihood of using cannabis among those who had used nicotine, and the majority of cannabis users had also used nicotine. While adolescence was the most common period for initiation, a considerable proportion of individuals initiated nicotine and cannabis use during emerging adulthood. These findings highlight the ongoing susceptibility of emerging adults to substance initiation and emphasize the potential harm of co-use of nicotine and cannabis, which should be a public health priority.