Assessing the Overlap Between Marijuana and Tobacco Use in Adults: A Mixed Methods Approach Open Access
Schauer, Gillian Leigh (2015)
Abstract
Tobacco use is more prevalent among people using other substances, including illicit drugs. Data suggest an overlap between tobacco and marijuana, the most widely used federally illicit substance in the U.S. Given the well-documented harms from tobacco, co-occurring tobacco use is an important and concerning comorbidity of marijuana use. Existing research on this topic focuses largely on adolescents and young adults. Nationally representative data on the prevalence of and trends in co-use among adults are not available, and are needed to characterize the extent of the epidemic in light of changing marijuana policies. Additionally, although a number of theoretical reasons have been proposed to explain overlapping use of marijuana and tobacco, no qualitative studies have been conducted with adults to understand reasons for and patterns of co-use. Accordingly, this mixed methods research sought to quantify and characterize co-use of marijuana and tobacco in adults. Data for the quantitative component of this research came from the 378,459 adults age 18 years and older who responded to the 2003-2012 National Survey on Drug Use and Health, a nationally representative, household interview survey conducted annually. Data for the qualitative component were collected from Washington State residents aged 18-34 years who reported past month use of both tobacco and marijuana (n=48). Taken together, findings suggest that co-use increased among the U.S. adult population between 2003-2012, with increases occurring among those ages 26-34 and 50+ years. Among adult marijuana users, blunt use (cigar wrappers filled with marijuana) increased significantly between 2005-2012, while cigarettes use decreased. Qualitative findings suggest that adults aged 18-34 years report using marijuana in specific ways (e.g., sequentially, co-administered, as substitutes) and for different reasons (e.g., to enhance the high, ease cravings or addiction to nicotine, help cut back on use of one or both substances, or when use of one substances is not available, appropriate or allowed), with qualitative themes differing based on frequency of use. These data provide an epidemiologic foundation to justify ongoing studies to prevent and reduce co-occurring marijuana and tobacco use in adults. Qualitative findings on reasons for co-use provide possible avenues for future, theory-based interventions.
Table of Contents
CHAPTER 1: Introductory Literature Review 1
Marijuana Use 1
Marijuana use among U.S. adults 1
Changing risk perceptions about marijuana 2
Changing marijuana use policies 3
Marijuana products and modes of use 4
Increasing potency of marijuana 5
Marijuana abuse and dependence 6
Health effects and comorbidity due to marijuana use 8
Tobacco Use 11
Tobacco use among U.S. adults 11
Tobacco products and modes of use 12
Nicotine abuse and dependence 13
Health effects and comorbidity due to tobacco use 14
Co-Use of Marijuana and Tobacco 15
Tobacco use among marijuana users 15
Marijuana use among tobacco users 16
Relationship with alcohol 17
Overlapping products and modes of use 17
Health effects of marijuana and tobacco co-use 19
Sociodemographic correlates of co-use 21
Reasons for Marijuana and Tobacco Co-Use 22
Shared mode of use 23
Physiologic effects 23
Shared environmental factors 24
Shared genetic factors 25
Limitations of Previous Research 26
Proposed Mixed-Methods Research 28
Quantitative studies 29
Qualitative study 30
Summary 31
References 33
CHAPTER 2: Trends in Patterns of Co-Use of Tobacco and Marijuana in Adults from 2003-2012
Abstract 61
Introduction 63
Methods 66
Results 69
Discussion 71
References 82
CHAPTER 3: Differences in Tobacco Product Use Among Past Month Adult Marijuana Users and Non-Users
Abstract 90
Introduction 92
Methods 95
Results 99
Discussion 102
References 112
CHAPTER 4: Differences in the Relationship of Marijuana and Tobacco by Frequency of Use: A Qualitative Study with Adults Aged 18-34 years
Abstract 120
Introduction 122
Methods 124
Results 127
Discussion 136
References 142
CHAPTER 5: Summary and Conclusions 147
References 156
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