Cigarette Smoking Among Marijuana Users in the United States

ABSTRACT

The vast majority of drug users smoke cigarettes. Most use marijuana and no other illicit drug. We analyzed adult responses to the 1997 NHSDA (n = 16,661) to explore relationships between marijuana use and cigarette smoking. Multivariate analyses controlled for other illicit drug use and other potential covariates. Nearly three-quarters of current marijuana users (74%) smoked cigarettes. Compared to nonusers, the adjusted odds of being a smoker were 5.43 for current marijuana users, 3.58 for past year marijuana users, and 2.02 for former marijuana users. Odds for cigarette smoking among current poly-drug users, compared to nonusers, were 2.3 to 1. Level of cigarette smoking was directly associated with frequency of marijuana use. Nationwide, an estimated 7 million adults smoke both substances and are at increased risk for respiratory illnesses and mortality. Cigarette smoking is a major co-morbidity of marijuana use and smoking cessation should be addressed among marijuana users in addition to their other illicit drug involvement.     

Drug Use among College Females: Socio-Demographic and Social Psychological Correlates

The purpose of this study was to determine whether socio-demo-graphic and social psychological variables are related to college female drug use. A questionnaire was administered to 38 female drug users and 93 female nonusers. All the participants in this study were undergraduates at the University of Vermont. Of the 37 socio-demo-graphic and social psychological variables tested by the chi square technique, statistically significant differences between drug users and nonusers at the 0.01 level were found for 10 of the variables. Drug users and nonusers were differentiated according to attitudes toward legalization of marijuana use and marijuana use as an enhancer of creativity; present religious affiliation; similarity of own religious affiliation and that of each parent; extent and nature of religious interest; initiation into alcohol use; previous use of cigarettes; frequency of current cigarette smoking; and initiation into cigarette smoking.     

Correlates of occasional cigarette and marijuana use: are teens harm reducing?

This paper examines characteristics that distinguish heavy and occasional cigarette and marijuana use among U.S. high school seniors. High school seniors who completed the 1994 Monitoring the Future survey (N = 15,929) were classified as nonusers, occasional users, and heavy users of cigarettes and marijuana. Level of use was examined with regard to degree of perceived risk of regular use, perceived risk of occasional use as well as several psychosocial factors previously shown to be associated with use (e.g., peer use, close friends' approval of use, and self-esteem). Involvement with other drugs and high-risk behaviors across levels of use was also examined. Heavy users of cigarettes or marijuana reported significantly lower perceived risk of regular use of each substance compared to occasional users. Heavy and occasional users did not generally differ with regard to perceived risk of occasional use. Compared to heavy users, occasional cigarette or marijuana users reported significantly lower rates of illicit drug use, heavy alcohol use, and high-risk driving behaviors as well as fewer problem behaviors and higher grades. Some adolescents may moderate their cigarette and marijuana use to minimize harmful effects they associate with heavier use (i.e., they may be practicing harm reduction). Additional research is needed to better understand controlled substance use, and incorporate this information into prevention and cessation programs.     

Cigarette smoking, illicit drug use, and routes of administration among heroin and cocaine users

Cigarette smoking is ubiquitous among illicit drug users. Some have speculated that this may be partially due to similarities in the route of administration. However, research examining the relationship between cigarette smoking and routes of administration of illicit drugs is limited. To address this gap, we investigated sociodemographic and drug use factors associated with cigarette smoking among cocaine and heroin users in the Baltimore, Maryland community (N=576). Regular and heavy cigarette smokers were more likely to be White, have a history of a prior marriage, and have a lower education level. Regular smoking of marijuana and crack was associated with cigarette smoking, but not heavy cigarette smoking. Injection use was more common among heavy cigarette smokers. In particular, regular cigarette smokers were more likely to have a lifetime history of regularly injecting heroin. Optimal prevention and treatment outcomes can only occur through a comprehensive understanding of the interrelations between different substances of abuse.     

A study investigating the acute dose-response effects of 13 mg and 17 mg Delta 9- tetrahydrocannabinol on cognitive-motor skills, subjective and autonomic measures in regular users of marijuana

Heavy use of marijuana is claimed to damage critical skills related to short-term memory, visual scanning and attention. Motor skills and driving safety may be compromised by the acute effects of marijuana. The aim of this study was to investigate the acute effects of 13 mg and 17 mg Delta 9-tetrahydrocannabinol (THC) on skills important for coordinated movement and driving and on subjective and autonomic measures in regular users of marijuana. Fourteen regular users of marijuana were enrolled. Each subject was tested on two separate days. On each test day, subjects smoked two low-nicotine cigarettes, one with and the other without THC. Seventeen mg THC was included in the cigarette on one test day and 13 mg on the other day. The sequence of cigarette types was unknown to the subject. During smoking, heart rate and blood pressure were monitored, and the subjects performed a virtual reality maze task requiring attention and motor coordination, followed by 3 other cognitive tasks (Wisconsin Card Sorting Test (WCST), a "gambling" task and estimation of time and distance from an approaching car). After smoking a cigarette with 17 mg THC, regular marijuana users hit the walls more often on the virtual maze task than after smoking cigarettes without THC; this effect was not seen in patients after they smoked cigarettes with 13 mg THC. Performance in the WCST was affected with 17 mg THC and to a lesser extent with the use of 13 mg THC. Decision making in the gambling task was affected after smoking cigarettes with 17 mg THC, but not with 13 m THC. Smoking cigarettes with 13 and 17 mg THC increased subjective ratings of pleasure and satisfaction, drug "effect" and drug "high". These findings imply that smoking of 17 mg THC results in impairment of cognitive-motor skills that could be important for coordinated movement and driving, whereas the lower dose of 13 mg THC appears to cause less impairment of such skills in regular users of marijuana.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.     

Young adults report increased pleasure from smoking cigarettes when drinking alcohol but not when using marijuana

Background: Among young adults, cigarette smoking is strongly associated with alcohol and marijuana use. The present study compared self-reported co-use of cigarettes and alcohol versus cigarettes and marijuana among young adults using cross-sectional survey data.

Methods: Participants were young adult cigarette smokers (age 18 to 25) who also reported past month alcohol or marijuana use enrolled in a randomized trial testing a smoking cessation intervention on Facebook. Participants self-reported extent of cigarette smoking under the influence of alcohol or marijuana and differences in perceived pleasure from cigarette smoking when drinking alcohol compared to using marijuana.

Results: Among cigarette smokers who drank alcohol and used marijuana in the past month (n?=?200), a similar percentage of cigarettes were smoked under the influence of alcohol (42.4%?±?31.2%) and marijuana (43.1% ±?30.0%). Among alcohol?+?marijuana users, perceived pleasure from smoking cigarettes was significantly greater when drinking alcohol versus when using marijuana (t₍₁₉₉₎?=?7.05, p?n?=?158) or only used marijuana (n?=?54).

Conclusion: Findings highlight greater perceived reward from smoking cigarettes when drinking alcohol compared to when using marijuana, informing smoking cessation interventions that target users of multiple substances.     

Alcohol, drugs, and substance use among Asian-American college students

Two hundred and forty eight self-identified Asian-American college students participated in this study that examined the prevalence rates and sociodemographic factors of substance use among Asian Americans in college. Using a Basic Demographic Questionnaire, Family of Origin Measure, Acculturation Lifestyle Survey, and Substance Use Checklist (all instruments were in English), prevalence rates were found to be comparable to or higher than a national sample: 94.5% lifetime prevalence and 78.6% current prevalence (past 30 days) of alcohol use; and higher current prevalence (past 30 days) of illicit drug use (9.5%) and of cigarette use (22.8%) than other Asians aged 12 and older (3.5% for illicit drugs and 17.7% for cigarettes) in a national survey. Male students and those who were employed were more likely to be current users (past 30 days) of drugs in general (15%) and marijuana (13.2%), and users of wine coolers (76.0%) and cigarettes (61.1%) in their lifetime. Being born overseas, years in the U.S., and preference for American TV/movies are associated with substance use. Asian Americans are not immune from substance use (or abuse) while in college. Culture-specific prevention is necessary.     

What are young adults smoking in their hookahs? A latent class analysis of substances smoked

RationaleHookah smoking continues to be a popular form of tobacco use, especially among college students. Although hookahs are commonly used to smoke tobacco, anecdotal evidence suggests other substances, including herbal shisha, marijuana and hashish may be used. However, little is known about the variety of substances smoked in hookahs, or correlates associated with different substances smoked.MethodsIn fall 2010, 3447 students from 8 colleges in N.C. completed an online survey.Results44% of students reported ever smoking tobacco from a hookah. Of those ever users, 90% reported smoking flavored tobacco in a hookah, 45% marijuana, 37% herbal (non-tobacco) shisha, and 18% hashish. Latent class analysis revealed two distinct classes. The most prevalent class (77%) primarily smoked flavored tobacco, with minimal use of herbal shisha and marijuana and virtually no use of hashish. The second class (23%) primarily smoked marijuana, hashish and flavored tobacco with moderate use of herbal shisha. Logistic regression analysis adjusting for clustering within schools revealed that males, illicit drug users, daily, nondaily and former cigarette smokers and those whose mothers had higher levels of education were significantly more likely to be in the second class compared to the first.ConclusionsRates of lifetime use of hookah were high in our sample of college students. While the majority of hookah users smoked tobacco in hookahs, they also smoked other substances, notably marijuana and herbal shisha. Prevention efforts should recognize that students are using hookahs to smoke a variety of substances.     

Tetrahydrocannabinol content and differences in marijuana smoking behavior

Changes in smoking behavior in response to a change in marijuana potency were measured in marijuana users. A marijuana cigarette containing 1.2% or 3.9% tetrahydrocannabinol (THC) was smoked on separate days by ten experienced users. Puff volume, duration and number, interpuff interval, inhalation volume and duration were averaged for each cigarette. The high potency cigarettes were smoked with more puffs and longer interpuff intervals, but also with greater inhaled volumes of air, thereby diluting the marijuana smoke.     

Rural High School Student Drug Use and the Effect of “Summer Jam, 1973” on Drug Use Patterns: The Watkins Glen Case

A sample of 138 rural high school students was surveyed with regard to their use of marijuana and other psychotropic drugs, factors influencing such use, and whether the rock music festival held in their community had an impact on marijuana use among these students. Users and nonusers were found to differ with regard to their use of other drugs, perception of sources influential in the users' decision to stop smoking marijuana, and in the nonusers' decision to not smoke marijuana. The rock music festival was not found to have had a direct impact on initiation into marijuana use. No users or nonusers used marijuana as a result of attending the festival.     

Effects of prenatal cigarette and marijuana exposure on drug use among offspring

The present study investigated whether maternal cigarette smoking and marijuana use during pregnancy were associated with an increased risk of initiation and daily/regular use of such substances among one hundred fifty-two 16- to 21-year-old adolescent offspring. The participants were from a low risk, predominately middle-class sample participating in an ongoing, longitudinal study. Findings indicated that offspring whose mothers reported smoking cigarettes during their pregnancy were more than twice as likely to have initiated cigarette smoking during adolescence than offspring of mothers who reported no smoking while pregnant. Offspring of mothers who reported using marijuana during pregnancy were at increased risk for both subsequent initiation of cigarette smoking (OR=2.58) and marijuana use (OR=2.76), as well as daily cigarette smoking (OR=2.36), as compared to offspring of whose mothers did not report using marijuana while pregnant. There was also evidence indicating that dose-response relationships existed between prenatal exposure to marijuana and offspring's use of cigarettes and marijuana. These associations were found to be more pronounced for males than females, and remained after consideration of potential confounds. Such results suggest that maternal cigarette smoking and marijuana use during pregnancy are risk factors for later smoking and marijuana use among adolescent offspring, and add to the weight of evidence that can be used in support of programs aimed at drug use prevention and cessation among women during pregnancy.     

Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States

Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N = 1113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-cigarettes, and 30.5% reported using e-cigarettes in the past 30 days (current users). The main reasons for using e-cigarettes were (a) at times/places when smoking was prohibited (53.5%), and (b) as a way to quit/reduce cigarette smoking (50.3%). Daily vs non-daily e-cigarette users were more likely to use e-cigarettes both as a way to reduce health risks, and as a way to quit/reduce cigarette smoking. A majority of e-cigarette users (87.1%) reported dual use of e-cigarettes and tobacco cigarettes during the past month. Among current cigarette smokers, those that also used e-cigarettes smoked more cigarettes per day, were more likely to have made a past year cigarette quit attempt, and to have tried nicotine replacement therapy compared to cigarette only smokers. There was a high rate of dual e-cigarette and cigarette use by persons enrolled in addiction treatment. E-cigarette users may be heavier cigarette smokers trying to quit or reduce their cigarette smoking. However, e-cigarettes were also used at times when individuals could not smoke cigarettes. Substance abuse treatment centers developing tobacco policies need to consider these potentially conflicting reasons for using e-cigarettes.     

The Epidemiology of Alcohol and Drug Abuse Among Adolescents

The primary purpose of this paper was to review systematically some of the more salient findings from a decade of research on the epidemiology of alcohol and drug abuse among adolescents. Data from most of the on-going nationwide studies regarding lifetime, past year, and past month use of various drugs were examined. While there is evidence of a downturn for some of the indicators, it is still too early to know if this is a temporary shift in rates or the beginning of meaningful trends toward lower levels of drug use. The second purpose was to challenge the alcohol and drug fields to consider more seriously the problem of multiple drug use and abuse. This was accomplished by showing that the relative percentage of youth who have used "only marijuana" has gone down as the percentage of youth who have used marijuana, other illicit durgs, and cigarettes and alcohol as well, has increased. Regression and discriminant analyses of data from the 1980 Monitoring the Future study of high school seniors reveals that variables that previously have differentiated users from nonusers are also useful in differentiating types of multiple drug users. The most important conclusion from this paper is that person characterized as "daily" users of marijuana are better typed as multiple drug users.     

Binge drinking and marijuana use among menthol and non-menthol adolescent smokers: Findings from the Youth Smoking Survey

Introduction

Research has shown that smoking menthol cigarettes induces smoking initiation and hinders cessation efforts especially among youth. The objective of this paper is to examine the association between menthol cigarette smoking and substance use among adolescent students in Canada.

Methods

A nationally representative cross-sectional sample of 4466 Canadian students in grades 7 to 12 from the 2010–2011 Youth Smoking Survey is analyzed. A bivariate probit model is used jointly to examine the association of menthol smoking status with binge drinking and marijuana use.

Results

32% of the current smokers in grades 7 to 12 smoke mentholated cigarettes, 73% are binge drinkers and 79% use marijuana. Results of the bivariate probit regression analysis, controlling for other covariates, show statistically significant differences in the likelihood of binge drinking and marijuana use between menthol and non-menthol smokers. Menthol cigarette smokers are 6% (ME = 0.06, 95% CI = 0.03–0.09) more likely to binge drink and 7% (ME = 0.07, 95% CI = 0.05–0.10) more likely to use marijuana.

Conclusion

Smoking menthol cigarettes is associated with a higher likelihood of binge drinking and marijuana use among Canadian adolescents. Banning menthol in cigarettes may be beneficial to public health.     

Self-report stability of adolescent substance use: are there differences for gender, ethnicity and age?

This study used the National Longitudinal Survey of Youth and is the first to examine a 2-year report stability of substance use among adolescents while stratifying for gender, ethnicity, and age. This study examined lifetime use and age at onset report stability, and the internal consistency of reports while excluding nonusers and incident cases (respondents who may have initiated substance use between the two reporting periods) from the analyses. Report agreement of lifetime use for each substance was over 80% and was highest among alcohol users and lowest for cigarette and marijuana users. Report agreement was higher for female compared to male cigarette users. External consistency of lifetime use of cigarettes and marijuana was higher for whites compared to Hispanic or African American adolescents. Internal consistency was high but lifetime use reports were more stable than age at onset reports.     

Substance use among night high school students in Japan]

OBJECTIVE: The aim of the present study was to determine the prevalence of tobacco use, alcohol drinking, and illicit drug use among night high school students in Japan. METHOD: 247 students (180 boys and 67 girls) from 3 night high schools were asked to complete self-administered anonymous questionnaires in classrooms. The average age of the participants was 18.7 years. RESULTS: Overall, 76.0% of the participants reported lifetime alcohol use, and 44.0% reported drinking alcohol during the past 30 days. Of the former, 24.6% reported experiencing alcohol-induced blackouts and 18.9% reported drinking alcohol without adult supervision at the age of 13 years or younger. 58.3% of the participants reported experimenting with smoking cigarettes, 42.3% reported having smoked cigarettes in the past 30 days, and 34.8% reported smoking cigarettes daily. 43.0% of the participants who had experienced smoking cigarettes had started smoking at the age of 13 years or younger. The lifetime prevalence of any illicit drugs was 9.8% for boys and 5.2% for girls; overall, it was 8.6%. The most commonly used illicit drugs were marijuana (6.4%), inhalants (6.4%), butane gas (4.5%), and nitrites (3.2%). CONCLUSIONS: Although the results showed that there were no significant differences in alcohol drinking experience between night high school and general high school students, problematic drinking behavior was observed. In the case of cigarette smoking, night high school students outnumber general high school students. In previous studies in Japan, the former population showed the highest prevalence of illicit drug use. These findings provide evidence that substance use represents a problem among night high school students. Based on this evidence, health education in night high schools should include not only zero tolerance for or abstinence from substance use but also secondary and tertiary prevention approaches.     

Support for Marijuana Legalization and Predictors of Intentions to Use Marijuana More Often in Response to Legalization Among U.S. Young Adults

Background: As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. Objective: This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Methods: Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18–34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Results: Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults.     

An Extension of Jessor and Jessor's Problem Behavior Theory from Marijuana to Cigarette Use

Results of a survey of nearly 5,000 high school seniors were analyzed to apply Jessor and Jessor's Problem Behavior Theory and Kandel's legal-illegal distinction in drug use to cigarette and marijuana smoking. The findings support the utility of conceptualizing cigarette use as a problem behavior within Problem Behavior Theory in that the patterning of cigarette correlates was functionally similar to that of marijuana. However, the degree of peer support for use was considerably greater for marijuana than for cigarettes, supporting Kandel's legal-illegal drug distinction. The additional explained variance in marijuana use in the current study attests to the importance of utilizing respondents' standards and perceived standards of reference sources in research on social influences on mood-altering substances among youth.