The Impact of Cannabis and Tobacco/Nicotine Product Co-Use in Young Adults: Prospective Cessation Evaluation and Substitution

PROJECT SUMMARY/ABSTRACT The co-use of tobacco/nicotine products and cannabis among young adults is prevalent and varies widely in terms of patterns and products of use. While nicotine-cannabis co-use may adversely affect treatment and other clinical outcomes, this area is understudied. Little is known regarding the treatment implications of co-use, particularly during an attempt to quit or reduce use of one or both substances. Cannabis co-use may impact nicotine cessation or may change during a cessation attempt, which is critical to understand and inform treatment strategies. Further, intervention work addressing youth poly-nicotine use (i.e., combustible cigarettes, nicotine vaping or e-cigarettes, hookah, smokeless, etc.) is an emerging area of study and the influence of cannabis co- use represents a potentially important variable to be incorporated into cessation strategies and to inform treatment guidelines for youth. To date, the impact of cannabis use on nicotine cessation outcomes is not well understood, even in the adult literature, and no prospective studies have evaluated the impact of cannabis use on nicotine cessation among young adults. This proposed R01 application is a completely remote, prospective 12-week nicotine cessation trial among young adults (ages 18-25; N=351) who use nicotine/tobacco products regularly (20+ days in the past 30; all product combinations will be included). We will leverage our ongoing collaboration with DynamiCare Health to administer remote contingency management (CM) focused on nicotine cessation through their commercially available mobile substance use treatment platform. Youth who co-use cannabis will be enrolled and oversampled (2:1). All participants will receive CM and psychosocial education for 12 weeks to support nicotine cessation (all products), while cannabis use will not be specifically addressed. Biochemical verification and self-reported nicotine and cannabis use will be collected throughout the trial. The aims of this proposed study are to; 1) examine the impact of cannabis co-use on nicotine cessation outcomes among youth co-users compared to nicotine only users (Aim #1), 2) among co-users of cannabis, assess changes in cannabis use during nicotine cessation treatment (Aim #2), and 3) explore cannabis demand through a behavioral economic paradigm during nicotine withdrawal/nicotine cessation attempt (Exploratory Aim #1). Cannabis co-use is prevalent in this population and may serve as an obstacle to successful nicotine cessation among co-users, in which case, addressing co-use will be essential in any intervention targeting abstinence from nicotine. Further, demand for cannabis use during a nicotine quit attempt among co-users has never been studied in the context of a treatment trial and will be important to informing the literature regarding compensatory cannabis use during nicotine quit attempts. Findings from this proposed R01 will be uniquely positioned to have substantial impact on treatment recommendations youth who are using multiple nicotine/tobacco products and co-use cannabis.