A University of Michigan study found that young Americans use nicotine, tobacco and cannabis in multiple ways — and for most users, smoking, the most dangerous method, is still part of the mix.

Funded by the National Cancer Institute and the National Institutes of Health, the research underscores that any use of nicotine, tobacco or cannabis is harmful to young people, says lead investigator Rebecca Evans-Polce, U-M research associate professor of nursing. She adds that knowing which products young people use, and how they combine them, can help design better interventions.

The study analyzed 2022–23 data from 8,722 people aged 12–34 in the Population Assessment of Tobacco and Health study who reported using nicotine, tobacco or cannabis in the past 30 days. Users averaged about two products during that period. Researchers identified six distinct subgroups of users:
– 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%

Majority still smoking

The largest group was combustible tobacco users, and several other major subgroups also involved combustible products, which are typically the most harmful.

“This is really important because there are known harms associated with using combustible products, especially combustible tobacco. 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,” Evans-Polce said.

Researchers also flagged the group that co-used multiple forms of nicotine, tobacco and cannabis as particularly concerning. “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 have diminished

Evans-Polce noted that the study found few differences between males and females. “That we didn’t see more differences in males and females is notable,” she 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.”

Overall, young people — 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 prevention and treatment resources may be especially important for these groups.

Continued surveillance is critical

Evans-Polce emphasized the need for ongoing monitoring, particularly as new product forms and regulations emerge. “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,” she said.

Future research may examine how different regulatory environments affect these use patterns and whether newer, less traditional forms of use are increasing among youth.

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

This article was adapted from an original report published on news-medical.net. All rights belong to the original publisher.