Multi-Modal Cannabis Use Among U.S. Young Adults: Findings from the 2022 and 2023 BRFSS in 23 States

Cannabis use among young adults in the U.S. has nearly doubled in recent years, driven by diverse methods of consumption and evolving cannabis legalization. Multi-modal cannabis use among young adults is an emerging public health issue that remains underexplored. This study examines the prevalence, patterns, and predictors of multi-modal cannabis use, defined as the use of two or more administration methods of cannabis use (e.g., smoking, vaping, edibles, dabbing, other forms) in the past month, among U.S. young adults aged 18-34 years. Data from the 2022-2023 Behavioral Risk Factor Surveillance System (BRFSS) across 23 states (n = 7635; weighted n = 7,482,134) show that 57% of young adults reporting current cannabis use engaged in multi-modal use, with dual- and triple-mode use being the most common. Factors associated with higher odds of multi-modal use include sexual minority status, poor physical health, frequent cannabis use, and co-use of electronic cigarettes and alcohol. Recreational cannabis legalization (RCL) is significantly linked to higher odds of multi-modal use. These findings underscore the interplay between individual risk factors and cannabis policy environments in shaping multi-modal cannabis use behaviors. To mitigate potential harms, targeted prevention strategies should prioritize young adults at risk for cannabis use, addressing both personal and policy-related factors influencing multi-modal cannabis use.