Trends in blunt smoking among adults in the United States, 2015-2022

We quantify and compare population-level trends in blunt smoking across demographics as well as behavioral and regulatory factors among adults in the US from 2015 to 2022.

We analyzed eight (8) years of data from the National Survey of Drug Use and Health (NSDUH). Participants were n = 326,087 adults; a subsample of n = 22,294 current blunt smokers was used to examine daily blunt smoking. We modeled linear trends in lifetime (ever), current (past 30-day), and daily (30/30 days) blunt smoking by: sex, race/ethnicity, age category, income, Major Depressive Episodes, alcohol use, and state-level cannabis regulatory policy.

From 2015 to 2022, lifetime blunt smoking increased ∼21.7 % (p < 0.001), current blunt smoking increased ∼34.4 % (p < 0.001), and daily blunt smoking among current users increased ∼24.5 % (p < 0.001). Lifetime blunt smoking increased significantly more among non-Hispanic White (23.7 %) and Hispanic (30.2 %) relative to non-Hispanic Black (8.6 %) adults; similar increases were observed among those older than 18-25 years. Current blunt smoking increased significantly greater among females (63.6 %) relative to males (19.0 %) and among those who did not use alcohol (92.3 %) relative to those who did use alcohol (23.4 %). Daily blunt smoking increased significantly greater among non-Hispanic White (80.4 %) relative to non-Hispanic Black (3.7 %) adults.

Blunt smoking increased substantially from 2015 to 2022. The greatest increases in blunt smoking were observed among females, older adults, and those who did not use alcohol; groups with historically lower rates of blunt smoking. Future study is needed to understand patterns of blunt initiation, escalation, and use disorder.