Concurrent Use of E-cigarettes, Combustible Cigarettes, and Marijuana

Area of Science:

• Adolescent health
• Substance use research
• Public health epidemiology

Background:

• Adolescent substance use patterns are evolving, with increased marijuana use alongside e-cigarette and cigarette use.
• Previous research identified subgroups of adolescent e-cigarette and cigarette users, but current patterns including marijuana require updated investigation.

Purpose of the Study:

• To identify and characterize subgroups of adolescent users of e-cigarettes, combustible cigarettes, and marijuana using recent data.
• To determine the behavioral correlates and psychosocial risk profiles associated with these distinct substance use subgroups.

Main Methods:

• Cross-classification of ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students from the 2019 Youth Risk Behavior Survey (YRBS).
• Comparison of 14 risk and protective factors across eight identified user groups using general linear models.
• Replication of analyses using 2017 YRBS data to ensure consistency of findings.

Main Results:

• Non-users comprised 43.9% of the sample. The most prevalent user groups were triple users (16.9%), dual e-cigarette and marijuana users (15.8%), and exclusive e-cigarette users (13.2%).
• Triple users exhibited significantly elevated psychosocial risk profiles compared to all other groups.
• Exclusive e-cigarette users showed higher risk than non-users but lower risk than dual users of cigarettes and marijuana.

Conclusions:

• The co-occurrence of e-cigarette, cigarette, and marijuana use is substantial among adolescents.
• This polysubstance use is associated with an elevated psychosocial risk profile, highlighting implications for epidemiology and prevention.
• Further research is necessary to understand the prevalence and pathways leading to triple substance use in adolescents.