Young Americans are using nicotine, tobacco and cannabis in many forms — but for most users, smoking remains involved, according to a new University of Michigan study. Smoking these products is among the most harmful ways to use them, researchers note.

Funded by the National Cancer Institute and the National Institutes of Health, the study was led by Rebecca Evans-Polce, U-M research associate professor of nursing, who says understanding which products young people use and how they combine them can help tailor better prevention and cessation efforts.

What the study looked at
The analysis used 2022–23 data from 8,722 people aged 12–34 in the Population Assessment of Tobacco and Health study who reported nicotine, tobacco or cannabis use in the past 30 days. On average, users reported about two different products during that period. Researchers identified six distinct user groups:
– Combustible tobacco: 31%
– Multiple forms of cannabis: 27%
– Vaping nicotine: 18%
– Multiple forms and co-use of nicotine, tobacco and cannabis: 14%
– Cannabis edibles: 5%
– Multiple forms and co-use of nicotine and tobacco: 5%

Smoking still common and harmful
The largest group was combustible tobacco users, and several other sizable groups also reported combustible products — typically the most dangerous forms of use. “This is really important because there are known harms associated with using combustible products, especially combustible tobacco,” Evans-Polce said. “Among those that used, combustible tobacco use and cannabis smoking remain some of the most predominant forms of use. And about 1 in 7 were using combustible tobacco and combustible cannabis. While cigarette use continues to decline overall, which is great, this shows this is still an important public health issue and we need to continue to put resources to smoking cessation efforts for young people.”

High-risk co-use patterns
Another concerning group reported co-using multiple forms of nicotine, tobacco and cannabis. “They reported using a lot of different types of nicotine and tobacco and a lot of types of cannabis,” Evans-Polce said. “We know that using multiple types exposes you to higher levels of carcinogens and toxins and can make it much harder to quit using.”

Sex differences narrowing
The study found few differences between males and females. “That we didn’t see more differences in males and females is notable,” Evans-Polce said. “The most recent research findings show generally that sex differences in alcohol and drug use have diminished, and in some cases disappeared among many age groups. So, this fits with this trend and suggests that females are now at just as high a risk for high risk patterns of cannabis and tobacco use as males.”

Young people need resources
Evans-Polce emphasized that youth, especially young adults, still need prevention and cessation resources. The study also found higher combustible tobacco use among males and Black and African American youth, indicating targeted prevention and treatment may be important for these groups.

Keep watching trends and regulations
Ongoing surveillance of product types and regulatory changes is critical, Evans-Polce said. “It is important to know what types of products are being used, especially among youth, so that our interventions are addressing these latest trends and are relevant to young people.” Future research may examine how different regulatory environments shape these use patterns and whether newer, less traditional forms of use are rising among young people.

Co-authors include Jessica Mongilio, Sean Esteban McCabe and Phil Veliz, all with the Center for the Study of Drugs, Alcohol, Smoking, and Health at the U-M School of Nursing.

Study: Heterogeneity in Nicotine, Tobacco, and Cannabis Use Among U.S. Adolescents and Adults Aged 12–34 Years

This article was adapted from an original report published on newswise.com. All rights belong to the original publisher.