Prevalence and Correlates of Cannabis Use and Co-use in Cigarette Smokers and Non-Smokers: An Emergency Department Study
Authors: Cunradi Carol , Caetano Raul , Ponicki William , Alter Harrison 
Published: March 2022

Background: Compared to the general household population, elevated rates of cannabis and cigarette smoking are found among adults seeking medical care at urban safety-net hospital Emergency Departments (ED). The goal of this study is to assess the prevalence and identify the demographic and psychosocial correlates of cannabis use with and without cigarette co-use in comparison to non-cannabis/tobacco users in an urban ED population. Methods: Secondary analysis was conducted on cross-sectional data collected in 2017 for a study on intimate partner violence, drinking and drug use among married/partnered adults ages 18-50 who were English or Spanish speakers seeking non-acute care at an urban ED (N=1,037; 53% female). Face-to-face survey interviews were conducted after obtaining informed consent from participants. We measured past 12-month cannabis use and past 30-day cigarette smoking. Data were collected on demographic (age, gender, level of education, race/ethnicity) and mental health factors (anxiety, depression, PTSD, past 12-month risky drinking [females/males drank 4+/5+ drinks]). Study participants were categorized as tobacco users without cannabis use (13.5%); cannabis users without tobacco use (13.8%); cannabis users with tobacco use (13.3%); and those who used neither substance (59.5%). We conducted chi-square analysis to examine the relationship between demographic and psychosocial factors and cannabis/tobacco co-use status, and multinomial logistic regression to estimate the factors associated with each type of cannabis/tobacco co-use category relative to non-users. Results: Approximately half of cannabis users smoked cigarettes. Compared to women, men had greater odds of smoking cigarettes without cannabis (aOR=3.26; 95% CI 2.12, 5.00), using cannabis without cigarettes (aOR=2.38; 95% CI 1.54, 3.69), or being a cannabis/tobacco co-user (aOR=3.72; 95% CI 2.30, 6.02). Latinx participants were less likely to smoke cigarettes without cannabis (aOR=0.24; 95% CI 0.10, 0.56), use cannabis without cigarettes (aOR=0.18; 95% CI 0.08, 0.42), or co-use cannabis/tobacco (aOR=0.05; 95% CI 0.02, 0.11) than white participants. Participant age was inversely associated with using cannabis without cigarettes (aOR=0.93; 95% CI 0.91, 0.96) and being a cannabis/tobacco co-user (aOR=0.95; 95% CI 0.93, 0.98). Regarding psychosocial factors, those who screened positively for anxiety had greater odds for using cannabis without cigarettes (aOR=1.93; 95% CI 1.20, 3.10) and being a cannabis/tobacco co-user (aOR=3.40; 95% CI 2.04, 5.66) compared to those who screened negatively. Those who screened positively for PTSD had elevated odds for using cannabis without cigarettes (aOR=1.65; 95% 1.00, 2.75) compared to those who screened negatively. Those who had engaged in risky drinking had greater odds of smoking cigarettes without cannabis (aOR=2.27; 95% CI 1.47, 3.48), using cannabis without cigarettes (aOR=2.54; 95% CI 1.61, 4.02), or being a cannabis/tobacco co-user (aOR=4.34; 95% CI 2.71, 6.97) compared to those who had not engaged in this behavior. Conclusions: Over one quarter of an urban ED sample used cannabis either with or without cigarettes. The results suggest that there are distinct demographic and mental health risk and protective factors associated with cannabis use and co-use in cigarette smokers and non-smokers. Cannabis users who smoke cigarettes may be especially vulnerable to mental health problems.