Elsevier

Drug and Alcohol Dependence

Volume 191, 1 October 2018, Pages 355-360
Drug and Alcohol Dependence

Full length article
Among whom is cigarette smoking declining in the United States? The impact of cannabis use status, 2002–2015

https://doi.org/10.1016/j.drugalcdep.2018.01.040Get rights and content

Highlights

  • Cigarette use is 2–3 times more common among cannabis users relative to non-users.

  • Non-daily cigarette smoking declined among non-daily cannabis users over time.

  • In contrast, non-daily cigarette smoking increased among daily cannabis users over time.

  • Daily cigarette smoking declined among daily and non-daily cannabis users.

  • Daily and non-daily cigarette use is declining among non-cannabis users in the US.

Abstract

Objectives

To 1) estimate changes in the prevalence of daily and non-daily cigarette smoking among current (past 30-day) daily, non-daily, and non-cannabis users in the United States (U.S.) population; 2) examine time trends in current (past 30-day) cigarette smoking in daily, non-daily, and non-cannabis users ages 12+ from 2002 to 2015.

Methods

Data collected annually from the 2002 to 2015 National Survey on Drug Use and Health (NSDUH) were employed. Linear time trends of daily and non-daily cigarette smoking were assessed using logistic regression with year as the predictor.

Results

In 2015, the prevalence of current (past 30-day) cigarette smoking was highest among daily (54.57%), followed by non-daily (40.17%) and non-cannabis users (15.06%). The prevalence of non-daily cigarette smoking increased among daily cannabis users from 2002 to 2015, whereas non-daily cigarette smoking declined among non-daily cannabis users and non-cannabis users from 2002 to 2015. Daily cigarette smoking declined among both cannabis users and non-users; the most rapid decline was observed among daily cannabis users, followed by non-daily and then by non-cannabis users. However, the relative magnitude of the change in prevalence of daily cigarette smoking was similar across the three cannabis groups.

Conclusions

Despite ongoing declines in cigarette smoking in the U.S., non-daily cigarette smoking is increasing among current cannabis users, a growing proportion of the U.S. population. Daily and non-daily cigarette smoking continue to decline among those who do not use cannabis. Efforts to further tobacco control should consider novel co-use-oriented intervention strategies and outreach for the increasing population of cannabis users.

Introduction

Cigarette smoking remains the leading preventable cause of death and disease worldwide (GBD 2015 Tobacco Collaborators, 2017GBD, 2015GBD 2015 Tobacco Collaborators, 2017). Within the United States (U.S.), smoking is responsible for 480,000 deaths annually; this amounts to more deaths each year than from human immunodeficiency virus (HIV), alcohol and illegal substance use, motor vehicle injuries, and firearm-related incidents, combined (Centers for Disease Control and Prevention, 2016a). The prevalence of smoking has declined tremendously in the U.S. since the mid-1960s, though it is currently estimated at approximately 15% in the US population (Centers for Disease Control and Prevention, 2016a). While the prevalence of smoking has declined among the general population, this decline has not been as dramatic among certain vulnerable groups (e.g., individuals who use alcohol and illicit substances).

Cigarette smoking is common among adults who use cannabis; estimates of cigarette smoking among current cannabis users range from 41 to 94% (Peters et al., 2012). Moreover, based on epidemiological data, the prevalence of cannabis use has been increasing over the past decade; estimates indicate that, between 2002 and 2014, the prevalence of cannabis use has increased significantly from 10.4% 13.3% (Compton et al., 2016). This pattern of co-use is troubling. A systematic review indicates that co-users of cannabis and tobacco are more likely to report cannabis use disorders and higher levels of psychosocial problems; as a result, comorbid users have greater difficulty quitting cannabis than do cannabis-only users (Peters et al., 2012). Further, co-users of cannabis and tobacco are at increased risk of toxicant exposure (Meier and Hatsukami, 2016)—including carbon monoxide, a contributor to cardiovascular and pulmonary disease (https://doi.org/10.1016/S0735-1097(01)01616-3)—and are at risk for numerous physical health morbidities, including respiratory distress (Moore et al., 2005; Taylor et al., 2000). Despite the observed decreases in the prevalence of cigarette smoking and increases in the prevalence of cannabis in recent years, it remains unknown whether and to what degree the prevalence of cigarette smoking has changed differentially among those who do and do not use cannabis over the same time period.

A number of studies have provided information on trends in tobacco use among cannabis users over time (Schauer et al., 2016, Schauer et al., 2017). Yet, unanswered questions remain. First, prior studies have examined multiple types of tobacco use combined—including cigarettes, cigars, pipe tobacco, blunts, and smokeless tobacco (Schauer et al., 2017), without separating out cigarette use from other tobacco use. Therefore, the trends in cigarette use vs. non-cigarette tobacco use has not been clear. This is especially relevant if the goal is to specifically understand trends in cigarette use given substantial co-use of cigarette use and alternative tobacco product use (e.g., blunt use; Fairman, 2015). Second, prior studies have examined any past month (Schauer et al., 2015, Schauer et al., 2016, Schauer et al., 2017) cigarette use among cannabis users, though the degree to which trends may differ by frequency of cigarette and/or cannabis use (i.e., daily versus non-daily) has not been examined. Taking into account the frequency of cigarette smoking, for instance, is particularly informative given that non-daily cigarette smokers appear to be quite distinct from daily smokers in several respects. Prior studies have suggested that—despite consistent evidence indicating the significant harms of non-daily cigarette use (Schane et al., 2010; U.S. Department of Health and Human Services, 2014)—non-daily cigarette smokers may not necessarily identify as “smokers” (Berg et al., 2009; Pulvers et al., 2014; Ridner et al., 2010), potentially reducing the likelihood that cessation messages will be perceived as salient, and therefore reducing effectiveness (Pulvers et al., 2014). Third, prior studies have not examined the potential impact of sociodemographic characteristics as potential moderators of these trends (Centers for Disease Control and Prevention, 2016a; Copeland and Swift, 2009; Guxens et al., 2007; Pacek et al., 2015). As a result, understanding the degree to which trends in cigarette smoking among individuals with various cannabis use status vary by demographic characteristics is critical to revealing whether various groups are differentially affected and may benefit from increased outreach and intervention.

In response to the above outlined gaps in the literature, the current study had three aims. The first was to investigate the relationship between current (past 30-day) cigarette smoking and current (past 30-day) cannabis use, stratified by demographic characteristics in 2015. The second aim was to estimate changes in the prevalence of past 30-day cigarette smoking among daily, non-daily, and non-users of cannabis from 2002 to 2015. The third aim was to estimate the prevalence of daily and non-daily cigarette smoking among daily and non-daily cannabis users, compared with non-users.

Section snippets

Methods

Data were obtained from the 2002 to 2015 National Survey on Drug Use and Health (NSDUH) public use data files, for a combined total sample size of 782,156 individuals. The NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is designed to provide estimates of the prevalence of extra-medical use of legal and illegal drugs in the household population of the U.S., age 12 and older. The survey employs a 50-state design with an independent multistage area

Past 30-day cigarette smoking and daily, non-daily, and non-cannabis use, by demographics, 2015

Past 30-day cigarette smoking was common among over half of daily cannabis users (54.57%; OR = 5.77, 95% CI = 4.83, 6.90) and among 40.17% of non-daily cannabis users (OR = 3.66, 95% CI = 3.30, 4.05) relative to 15.06% of non-cannabis users (Table 1). The strength of these relationships differed significantly by age, income, and race/ethnicity. The associations between daily cannabis use and cigarette smoking were stronger among individuals aged 12–17 (aOR = 41.80, 95% CI = 23.88, 73.18)

Discussion

To our knowledge, the present study is the first to examine trends in daily and non-daily cigarette smoking over time, stratified by frequency (daily, non-daily, no use) of current (past 30-day) cannabis use, in a nationally representative U.S. sample over the past decade. The study had several key findings. First, the prevalence of non-daily cigarette smoking has been increasing significantly among daily cannabis users over time (from 14.34% in 2002–17.86% in 2015). This is in contrast to the

Role of the funding source

Research reported in this publication was supported by the National Institute on Drug Abuse grants R01DA20892, K01DA043413, K24DA036955, and R01DA044171.

Conflict of interest

The authors have no conflicts of interest to declare.

Contributors

Authors Goodwin and Pacek conceptualized the research question. Author Pacek conducted the analyses, and wrote the first draft of the manuscript. Authors Copeland, Dierker, Cunningham, Martins, and Goodwin have critically reviewed, revised, and approved of the final manuscript.

References (37)

  • E. Meier et al.

    A review of the additive health risk of cannabis and tobacco co-use

    Drug Alcohol Depend.

    (2016)
  • B.A. Moore et al.

    Relapse in outpatient treatment for marijuana dependence

    J. Subst. Abuse Treat.

    (2003)
  • L.R. Pacek et al.

    Perceived risk of regular cannabis use in the United States from 2002 to 2012: differences by sex, age, and race/ethnicity

    Drug Alcohol Depend.

    (2015)
  • G.L. Schauer et al.

    Assessing the overlap between tobacco and marijuana: trends in patterns of co-use of tobacco and marijuana in adults from 2003–2012

    Addict. Behav.

    (2015)
  • G.L. Schauer et al.

    Prevalence, correlates, and trends in tobacco use and cessation among current, former, and never adult marijuana users with a history of tobacco use, 2005–2014

    Addict. Behav.

    (2017)
  • A.J. Budney et al.

    The time course and significance of cannabis withdrawal

    J. Abnorm. Psychol.

    (2003)
  • Center for Behavioral Health Statistics and Quality

    2015 National Survey on Drug Use and Health Public Use File Codebook

    (2016)
  • Centers for Disease Control and Prevention

    Current Cigarette Smoking Among Adults in the United States

    (2016)
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