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Published on: May 30, 2025
Adding tobacco to cannabis--its frequency and likely implications.
Richard E Bélanger1, Christina Akre, Emmanuel Kuntsche
1Research Group on Adolescent Health, Institute for Social and Preventive Medicine, Rte de la Corniche 2, Bâtiment Biopôle 1, Epalinges, Switzerland.
Summary
Mulling, adding tobacco to cannabis joints, is common among young cannabis users, particularly daily cigarette smokers. This practice increases nicotine exposure and should be considered in adolescent substance use assessments.
Area of Science:
- Adolescent substance use
- Cannabis and tobacco co-use
- Nicotine addiction research
Background:
- Young cannabis users face higher risks of cigarette initiation and nicotine addiction.
- Mulling, the addition of tobacco to cannabis, is a prevalent practice among adolescents.
Purpose of the Study:
- To determine the frequency of mulling among young cannabis users.
- To investigate how mulling practices differ based on cigarette smoking status.
Main Methods:
- Utilized data from the 2007 Swiss European School Survey Project on Alcohol and other Drugs (ESPAD).
- Surveyed 881 past-month cannabis users (mean age 15) on mulling habits via anonymous questionnaire.
- Categorized participants by cigarette smoking status: daily, occasional, former, and never-smokers.
Main Results:
- Four out of five cannabis users reported frequent mulling.
- Daily cigarette smokers exhibited the highest mulling frequency (90.3%).
- Daily cigarette smokers were significantly more likely to report frequent mulling compared to never-smokers (RR=3.56).
Conclusions:
- Mulling is a common behavior among young cannabis users, especially those who also smoke cigarettes.
- A majority of adolescent cigarette abstainers also frequently mull cannabis.
- Mulling represents significant nicotine exposure and should be addressed in adolescent substance use interventions.
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