Cigarette and cannabis use and co-use among U.S. adults: An examination of prevalence and trends during 2015–2023

Background The shifting dynamics of cannabis legislation in the U.S. has over half the states legalizing recreational use for adults and others opting for decriminalization. As tobacco use wanes, the surge in cannabis use presents a worrisome trend among adults. This study examines cigarette and cannabis use and co-use among U.S. adults from 2015 to 2023, emphasizing key sociodemographic variations. Methods Utilizing the National Survey on Drug Use and Health, we explored the prevalence and trends of past 30-day cigarette and cannabis co-use, cannabis-only use, and cigarette-only use among adults 18 and older over three periods: 2015–2019, 2020, and 2021–2023. Analyses were conducted across various sociodemographic factors, and predictors of substance use were identified using multivariable logistic regressions. Results Cannabis-only use increased from 3.9% to 6.5% in 2015–2019, was 7.1% in 2020, and increased again from 7.9% to 10.6% in 2021–2023. Cigarette-only use decreased from 15.0% to 12.0% in 2015–2019, was 10.3% in 2020, and declined again from 10.8% to 8.8% in 2021–2023. Co-use was relatively stable across the different periods. Among socioeconomically disadvantaged adults (with lower education, income, or lacking insurance), cigarette-only use was most prevalent. In contrast, cannabis-only use predominated among more socioeconomically advantaged groups (college-educated, high-income, and privately insured). Conclusion Cannabis-only use and co-use trends pose public health risks akin to cigarettes, necessitating targeted prevention campaigns. A multi-pronged strategy of public health education, early detection, and effective treatment development is vital to prevent cannabis from becoming the next public health crisis.