Reactivity to electronic nicotine delivery system (ENDS) cues in adults who smoke cigarettes and vape cannabis

Prior research shows that in-person exposure to electronic nicotine delivery systems (ENDS) use increases desire for both cigarettes and ENDS. Distinct from nicotine ENDS use, cannabis vaping is on the rise, often in conjunction with nicotine vaping or combustible cigarettes, marking a need to understand how co-use impacts ENDS cue reactivity. This study leverages a remote cue-delivery paradigm to evaluate the impact of co-use of cigarettes and cannabis on reactivity to a remote ENDS cue.

A cannabis co-use group (N = 45, individuals who smoke cigarettes and vape cannabis) and a non-co-use group (n = 61, individuals who smoke cigarettes and do not vape cannabis) observed a study confederate drinking bottled water (control cue) and vaping an ENDS (active cue). Desire to use a cigarette, ENDS and cannabis were measured before the cues (baseline), post-water and post-ENDS cue.

Multilevel models, controlling for sex and weekly ENDS use, examined cue reactivity across the co-use and non-co-use groups. Those who vaped cannabis in the past year reported both higher baseline ENDS and cannabis desire and heightened responses to the ENDS cue such that cue exposure significantly increased their desire for cigarettes, ENDS and cannabis.

This study provides the first evidence for differential ENDS cue-elicited desire in those who smoke cigarettes and vape cannabis. These findings suggest that co-use of cannabis and cigarettes may increase vulnerability to cravings, indicating a need for tailored prevention and intervention strategies for individuals who use both substances.