Cannabis and Tobacco/Nicotine Co-Use Common Among Young Adults Interview with:

Joan S. Tucker, Ph.D.Senior Behavioral ScientistRAND CorporationSanta Monica, CA

Dr. Tucker

Joan S. Tucker, Ph.D.
Senior Behavioral Scientist
RAND Corporation
Santa Monica, CA What is the background for this study?  

Response: In light of young adults’ expanding access to cannabis through legalization for recreational use, there has been growing interest in the co-use of cannabis with tobacco/nicotine products.  Although existing data show that young adults who use cannabis products also tend to use tobacco/nicotine products, little is known about how these products are typically used together.

Existing research on co-use has mostly focused on combustible products, not accounting for the recent proliferation in cannabis and tobacco/nicotine product types and methods of use (e.g., vaping). Further, not much is known about whether there are important differences between types of co-use (e.g., using both products on the same occasion, one right after another, but not mixing them vs. using both products by mixing them in the same delivery device) in terms of heaviness of use, consequences from use, or associations with young adult functioning.

This study was designed as an important first step toward understanding cannabis and tobacco/nicotine co-use behavior among young adults and addressing these gaps in the research literature. What are the main findings?

Response: In a predominantly California-based sample of 2,429 young adults (mean age = 20.7 years), 50% reported cannabis use, 43% reported tobacco/nicotine use, and 37% reported co-use of both cannabis and tobacco/nicotine in the past year.  The most common method of cannabis and tobacco/nicotine co-use was smoking combustible products (e.g., cigarettes, joints, bongs, blunts).  Vaping methods for co-use were somewhat less common.

We also compared 5 mutually exclusive groups, based on respondents’ self-reported past year use of cannabis and tobacco/nicotine:
(a) single substance use;
(b) concurrent use only (using both products, but only on separate occasions);
(c) sequential use only (using both products on the same occasion, one right after the other, but not mixing them together);
(d) coadministration only (using both products on the same occasion by mixing them in the same delivery device); and
(e) both sequential use and coadministration.

Overall, individuals who co-used both cannabis and tobacco/nicotine on the same occasion in some way reported heavier use and greater problematic behaviors (for example, marijuana consequences, marijuana selling, driving after using marijuana) than those who did not.  Sequential use (especially among those that also engaged in co-administration) was typically associated with worse self-reported physical and mental functioning overall compared to using each substance separately. What should readers take away from your report?

Response: Cannabis and tobacco/nicotine co-use is common among young adults.  In fact, 80% of the young adults in our sample who reported past year cannabis use also reported past year tobacco/nicotine use.  Our findings suggest that we can no longer just think about the consequences of using cannabis or tobacco/nicotine alone – we have to start thinking about the issue of co-use in terms of our research studies, prevention and treatment efforts, and public policy.  It is particularly important to understand how young people are using cannabis and tobacco/nicotine products together because different types of co-use may pose different health risks and have different implications for young adult functioning. What recommendations do you have for future research as a result of this work?

 Response: First, more research is needed to better understand the reasons underlying these co-use group differences in young adult functioning. From this study we cannot determine whether these differences are due to the ways in which cannabis and tobacco/nicotine are being used, characteristics of the young adults who choose to use these substances together in a particular way, or some other factors.  Second, we need additional research to identify adolescents who may be at particular risk for future sequential use and co-administration (the two highest risk co-use groups) in order to inform prevention efforts.  Finally, there is a need for evidence-based programs that specifically focus on reducing cannabis and tobacco/nicotine co-use among young people.


Psychol Addict Behav. 2019 Apr 15. doi: 10.1037/adb0000464. [Epub ahead of print]

Types of cannabis and tobacco/nicotine co-use and associated outcomes in young adulthood.

Tucker JS1, Pedersen ER1, Seelam R1, Dunbar MS1, Shih RA1, D’Amico EJ1.


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Last Updated on April 30, 2019 by Marie Benz MD FAAD