Elsevier

Drug and Alcohol Dependence

Volume 141, 1 August 2014, Pages 159-162
Drug and Alcohol Dependence

Short communication
Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers

https://doi.org/10.1016/j.drugalcdep.2014.05.015Get rights and content

Abstract

Background

Marijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use.

Methods

Participants were 165 adolescents (13–17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS).

Results

The adolescent sample (mean age = 16.1 years, SD = 0.95) averaged 3.0 CPD (SD = 3.0) for 1.98 years (SD = 1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25–44% of the variance for all four measures of adolescent nicotine dependence.

Conclusions

Marijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

Section snippets

Background

Marijuana is the most widely used illicit substance worldwide (UNDOC, 2010). In 2010, more US high school students used marijuana in the prior 30 days than tobacco (Johnston et al., 2011). Co-use with tobacco is of increasing interest (Akre et al., 2010, Ramo et al., 2012, Soldz et al., 2003). Smoking marijuana with tobacco, either in a tobacco leaf (i.e. blunt) or mixed with tobacco, is an increasingly common practice among adolescents (Golub et al., 2005) thought by some users to prolong the

Participants

Adolescents between the ages of 13–17 from the San Francisco Bay Area who smoked at least 1 cigarette in the past 30 days were recruited as part of an ongoing smoking trajectory study detailed elsewhere (Rubinstein et al., 2013). Adolescents responding to online, school and clinic-based advertising were invited to complete the study visit. Participants were screened to exclude those who had used any form of nicotine replacement in the prior month. Females with positive pregnancy tests were

Results

Two hundred adolescents were consented into the study and completed the baseline visit. Of those, 28 denied smoking cigarettes in the past 30 days and 7 declined to answer the question about marijuana use and were thus excluded from the analysis. The resulting sample (N = 165, 64% female) had a mean age of 16.1 years (SD = 0.95) and was racially diverse, with 28% participants identifying as White, 19% African American, 19% Hispanic and 34% other. Participants averaged 3.01 CPD (SD = 3.0) for a

Discussion

Marijuana smoking was prevalent in this adolescent sample of tobacco smokers: 80% reported past month marijuana use and more than a third smoked marijuana daily. Notably, among adolescent tobacco smokers who also smoked marijuana, the frequency of marijuana use was associated with greater levels of nicotine addiction on all three major scales used in studies with adolescents plus the ICD-10. Moreover, models incorporating age, frequency and years of tobacco smoking with marijuana accounted for

Role of funding source

Funding for this study was provided by NIDA Grant R01 DA036508; the NIDA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

All authors made: (1) substantial contributions to the conception and analysis and interpretation of data; (2) drafting the article and revising it critically for important intellectual content; and (3) gave final approval of the version to be published.

Conflict of interest

All authors declare that they have no conflicts of interest. None of the authors have sources of funding, direct or indirect, and/or any connection with the tobacco industry.

Acknowledgments

The authors would like to thank Ms. Jennifer Simington, Ms. Grace Wu and Mr. Max Berlyant for their assistance with data collection and participant recruitment.

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