Tobacco and Cannabis Co-use by HIV Status Among United States Adults: Results from the 2021-2023 National Survey on Drug Use and Health.

Tobacco and cannabis use are prevalent among adults with HIV and co-use is associated with drug dependence and negative health outcomes such as lung disease. This study examined the co-use of tobacco and cannabis by HIV status overall and by sociodemographics. Data came from the adult sample from the 2021-2023 National Survey on Drug Use and Health. Adjusted multinomial logistic regressions were performed on tobacco cannabis co-use by HIV status, adjusting for covariates. We tested potential interaction effects between HIV status and each sociodemographic factor (i.e., age, sex, race/ethnicity, income, state-level medical cannabis legalization status) on the outcome. Among total adult respondents (N = 139,524), 0.4% (weighted) reported lifetime HIV diagnosis and 8.2% reported past-month tobacco and cannabis co-use. After adjusting for covariates, adults with HIV, compared with adults without HIV, were more likely to report past-month tobacco and cannabis co-use (aRRR = 3.35, 95% CI = 1.79, 6.27). We also observed that race/ethnicity and state-level medical cannabis legalization status modified the association between HIV diagnosis and tobacco and cannabis co-use. This study observed a higher prevalence of tobacco and cannabis co-use among adults with HIV overall and identified subgroup sociodemographic differences by race/ethnicity and state-level medical cannabis legalization.