Prevalence and correlates of tobacco and cannabis co-use among late middle-aged (50-64 years) and older adults (65+ years) in the United States using pooled national survey data.

Abstract

Background: Adults in later life (ages 50+) are disproportionately impacted by tobacco morbidity and mortality. While tobacco prevalence has stagnated, cannabis use prevalence is rising at higher rates for older (vs. younger) age groups.

Objective: To update the literature and better characterize co-use in older age using nationally representative data.

Methods: National Survey on Drug Use and Health 2015-2019 data were used to assess the prevalence of past-month tobacco-only, cannabis-only, and tobacco and cannabis co-use among adults 50+ years (N = 43,963) in late middle-age (50-64) and older adulthood (65+ years). Multinomial logistic regressions explored sociodemographic/health characteristics associated with past-month co-use and cannabis-only use (vs. tobacco-only). We characterized past-year healthcare visits by use patterns.

Results: One in five adults 50+ years reported past-month tobacco and/or cannabis use. Past-month co-use was higher in middle-age (3.5%) than older age (0.8%). Co-use was more likely among individuals reporting fair/poor health (vs. excellent/very good) (adjusted risk ratio [aRRR] = 1.27, 95% confidence interval [CI] = 1.01, 1.60), and with past-year mental illness (aRRR = 1.67, 95% CI = 1.39, 2.01). Cannabis-only use (vs. tobacco-only) was more likely among those with mental illness, yet less likely among those with good or fair/poor health than excellent/very good health. Most (90.2%) had any past-year healthcare contact, with all visit types overrepresented by tobacco-only use.

Conclusion and scientific significance: Older U.S. adults with poorer physical and mental health were more likely to report past-month co-use than tobacco-only. These data uniquely describe the prevalence and characteristics of adults 50+ years in the U.S. who co-use tobacco and cannabis use.