Cannabis and Tobacco Product Use Classes and Psychosocial Correlates Among US Young Adults

This study examined US young adults' cannabis-tobacco use classes.

Latent class analysis used 2023 data among young adults (ages 18-34, purposively recruited via Facebook to represent ~50% past-month cannabis use), specifically the 2267 reporting past-month cannabis and/or tobacco use. Indicators included: cannabis, cigarette, and e-cigarette use (0 days, infrequent [1-10], frequent [11-30]) and any cigar, hookah, smokeless tobacco, and nicotine pouch use. Multivariable regressions examined sociodemographics, adverse childhood events (ACEs), mental health, and personality characteristics in relation to class.

Five classes were identified: (#1) "primarily cannabis" (36.6%): all used cannabis (74.0% infrequent), <14% tobacco products; (#2) "frequent cannabis-cigarette" (34.2%): 86.7% cannabis (82.9% frequent), 65.9% cigarettes (51.6% frequent), 59.4% e-cigarettes (33.6% frequent), <37% other tobacco; (#3) "product-dabbling" (16.0%): 79.8% cannabis, 71.8% cigarettes, 66.7% e-cigarettes (largely infrequently used each), <40% other tobacco; (#4) "frequent poly-product" (7.7%): 93.9% cannabis, 90.9% cigarettes, 98.2% e-cigarettes (~half frequently used each), >84% other tobacco; and (#5) "primarily e-cigarette" (5.5%): all used e-cigarettes (51.0% frequent), <9% other tobacco. Correlates of class #4 membership were: being Black (vs. White) and more mental health symptoms versus other classes; being Hispanic versus #2 and #5; being heterosexual (vs. other) vs. classes #1-#3; being older and male and higher extraversion versus #1 and #5; in non-legalized states versus #1; more ACEs versus #1, #3, and #5; and higher neuroticism and less openness versus #1-#2.

The frequent poly-product class represented characteristics (eg, race/ethnicity, sexual minority, mental health) implicated in substance use-related disparities, underscoring the need for targeted intervention.

Relatively few studies have assessed classes of cannabis and tobacco use among young adults, with few assessing key psychosocial determinants. This study examined cannabis and tobacco use classes among US young adults and psychosocial and sociodemographic correlates. Findings documented a frequent poly-product use class, displaying high-risk substance use behaviors and related psychosocial risk factors (eg, mental health symptoms, ACEs), as well as classes using less often and fewer products with lower psychosocial risks. Moreover, sociodemographic profiles of these classes reflect known substance use disparities. Findings underscore the importance of tailored interventions addressing substance use, mental health, and related disparities.