Significance Cannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD).
Methods Data were drawn from the 2002–2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1–5 CPD; moderate, 6–15 CPD; heavy, 16+ CPD).
Results Across all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use.
Conclusions US individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.
- co-substance use
- public policy
Data availability statement
Data are available in a public, open access repository. Data used for the study were extracted from the National Survey on Drug Use and Health public data portal (http://datafiles.samhsa.gov/).
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Contributors RDG conceived of the study and data analysis plan and contributed to the interpretation of the data and drafting of the manuscript. AHW contributed to the data analysis plan and interpretation of the data, and wrote the first draft of the manuscript. LD and JZ conducted the statistical analysis. LD also contributed to the drafting of the manuscript. JL contributed to the literature review and manuscript preparation. All authors have contributed to and approved the final draft of the manuscript. RDG accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This work was supported by the National Institute on Drug Abuse (grant R01-DA20892 to RDG) and the National Cancer Institute (grant R21-CA226300 to LD).
Disclaimer The funders had no role in the design, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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