Cannabis Use Is Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse Among Adults in the United States

Abstract

Introduction Despite increasing use of cannabis, it is unclear how cannabis use is related to cigarette transitions. This study examined cannabis use and smoking initiation, persistence, and relapse over 1 year among a nationally representative sample of US adults. Methods Data were from US adults (≥18 years) who completed two waves of longitudinal data from the Population Assessment of Tobacco and Health Study (Wave 1, 2013–2014; Wave 2, 2014–2015; n = 26 341). Logistic regression models were used to calculate the risk of Wave 2 incident smoking among Wave 1 never-smokers, smoking cessation among Wave 1 smokers, and smoking relapse among Wave 1 former smokers by Wave 1 cannabis use. Analyses were adjusted for age, gender, race/ethnicity, income, and education. Results Among Wave 1 never-smokers, cannabis use was associated with increased odds of initiation of nondaily (adjusted odds ratio [AOR] = 5.50, 95% confidence limits [CL] = 4.02–7.55) and daily cigarette smoking (AOR = 6.70, 95% CL = 4.75–9.46) 1 year later. Among Wave 1 daily smokers, cannabis use was associated with reduced odds of smoking cessation (AOR = 0.36, 95% CL = 0.20–0.65). Among Wave 1 former smokers, cannabis use was associated with increased odds of relapse to daily and nondaily cigarette smoking (daily AOR = 1.90, 95% CL = 1.11–3.26; nondaily AOR = 2.33, 95% CL = 1.61–3.39). Conclusions Cannabis use was associated with increased cigarette smoking initiation, decreased smoking cessation, and increased smoking relapse among adults in the United States. Increased public education about the relationship between cannabis use and cigarette smoking transitions may be needed as cannabis use becomes more common among US adults. Implications As cannabis use increases in the United States and other countries, an evaluation of the relationships of cannabis use to other health-related behaviors (eg, cigarette smoking) is needed to understand the population-level impact of legalization. Little is known about associations between cannabis use and cigarette smoking transitions (1) using recent longitudinal data, (2) among adults, and (3) examining transitions other than smoking initiation (eg, smoking relapse). Our results suggest that among US adults, cannabis use was associated with increased cigarette smoking initiation among never-smokers, decreased cigarette smoking cessation among current smokers, and increased cigarette smoking relapse among former smokers.

Prevalence, Trends, and Distribution of Nicotine and Marijuana use in E-cigarettes among US adults: The Behavioral Risk Factor Surveillance System 2016–2018

“…3 Importantly, marijuana use has also been linked with cigarette smoking initiation ("reverse gateway effect"). 23 Thus it is concerning that 32.1% and 54.5% of dual vapers and marijuana-predominant vapers were never smokers, respectively, compared to 24% of nicotine-predominant vapers in our analysis, with implications for increased transition to cigarette smoking especially among the marijuana vapers. Additionally, a sizeable portion of these 2 sub-populations were current smokers (~24% and 11% of dual and marijuana-predominant vapers, respectively) which highlights greater polysubstance use in these 2 groups.…”

Emerging Indoor Air Laws for Onsite Cannabis Consumption Businesses in the U.S.

“…From an air quality perspective, there is no distinction between cannabis smoke and tobacco smoke, but this provision may discourage the co-use of tobacco and cannabis. Cannabis use predicts tobacco use onset, 61 and co-use is associated with higher toxicant exposure 62 and decreased smoking cessation. 63 Illinois allows tobacco and cannabis to be consumed at the same business location, and no local laws in Illinois prohibiting this activity were found.…”

Cohort Study of Cannabis Use History and Perinatal Cigarette Use Among Overweight and Obese Women

“…A substantial body of evidence from studies of nonpregnant individuals suggests that the dual use of cannabis and tobacco impedes tobacco smoking cessation efforts. Cannabis users in studies from nationally-representative samples are less likely to successfully quit smoking cigarettes than individuals who do not use cannabis (Lesueur et al, 2018;Weinberger et al, 2020). Among former smokers, individuals who use cannabis are more likely to experience lapses and relapse to smoking cigarettes (Rogers et al, 2020;Weinberger et al, 2018Weinberger et al, , 2020.…”

“…Cannabis users in studies from nationally-representative samples are less likely to successfully quit smoking cigarettes than individuals who do not use cannabis (Lesueur et al, 2018;Weinberger et al, 2020). Among former smokers, individuals who use cannabis are more likely to experience lapses and relapse to smoking cigarettes (Rogers et al, 2020;Weinberger et al, 2018Weinberger et al, , 2020. Findings are less clear for treatment-seeking samples, with some indication that cannabis use is linked to lower rates of reduction or abstinence among those individuals seeking treatment for tobacco smoking cessation (e.g., Gourlay et al, 1994;McClure et al, 2019) and other studies finding no effect of cannabis use on cessation outcomes (e.g., Hendricks et al, 2012;Streck et al, 2017).…”