Examining the Relationship of Cannabis use Patterns, Mental Health, and Sociodemographic Factors: A Focus on Cannabis Vaping, Smoking and Dual-Use.

Background: Cannabis vaping, and co-use with cannabis smoking, can exacerbate the risks of developing respiratory diseases and cannabis dependence. This study aims to examine the mental health profiles and sociodemographic correlates of adults who vape cannabis and engage in dual cannabis use (vaping/ smoking), compared to those who smoke cannabis.

Methods: The most recent, cross-sectional wave of the Population Assessment of Tobacco and Health Study (Wave 6) was used in this study. Data were restricted to adults (18 + years) who currently use cannabis (n = 7,178). Participants were classified as 'cannabis smoking only,' 'cannabis vaping only,' 'dual-use,' or 'other cannabis use methods only.' Multinomial logistic regression was used to examine the sociodemographic, internalizing and externalizing symptom factors of cannabis vaping and dual-use compared to cannabis smoking.

Results: Over 56 % of participants currently smoked cannabis only, 9.1 % vaped cannabis only, while 20.0 % were engaging in dual-use. Adults experiencing severe externalizing symptoms (vs. mild symptoms) had higher odds of engaging in dual-use than smoking cannabis only (OR = 1.89, 99.5 %CI: 1.48, 2.40). Those with White racial background (vs. African-American background) (OR = 3.90, 99.5 %CI: 2.31, 6.58) and earning a higher income (vs. lower income) (OR = 2.56, 99.5 %CI: 1.79, 3.66) had higher odds of currently vaping cannabis only, compared to smoking cannabis only.

Conclusions: Our study has identified that mental health plays a significant role in cannabis use patterns, particularly with externalizing symptoms which are related to aggression and diagnoses of attention deficit disorders. This highlights the need for healthcare and mental health providers to address mental health symptoms when managing adult cannabis use.