Old habits die hard: U-M study shows most young nicotine, cannabis users are still lighting up

Young Americans use nicotine, tobacco and cannabis in multiple ways, but smoking those items––the most dangerous method––is still involved for most users, a new University of Michigan study found.

The research, funded by the National Cancer Institute and the National Institutes of Health, is important because using any type of nicotine, tobacco or cannabis product is harmful to young people, says lead investigator Rebecca Evans-Polce, Ph.D., U-M research associate professor of nursing. Understanding the types of products they use most, and if and how they’re used together, can help develop better interventions, she says.

The study used 2022–23 data from 8,722 individuals aged 12-34 in the Population Assessment of Tobacco and Health study who reported using nicotine, tobacco or cannabis in the past 30 days. Researchers found that users averaged about two products in that period, and classified users into six distinct user subgroups: 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 are still smoking tobacco

The largest subgroup was combustible tobacco, and several other large subgroups still reported using 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,” 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.”

Also concerning is the group that co-used 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 have diminished

“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 in general are still in need of cessation and prevention resources, particularly young adults, she said. Researchers also found higher combustible tobacco among males and Black and African American youth, suggesting prevention and cessation treatment resources may be important for these populations.

Continued surveillance is critical

Evans-Polce said continued surveillance, especially of new product forms and regulations, is key.

“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.

Further research may include examining how different regulatory environments impact these use patterns and if there are increases in these newer and less traditional forms of use among youth.

Co-authors 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.

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