Trends in use of tobacco and cannabis across different alcohol consumption levels in the United States, 2010-19.

Aims: People often drink alcohol and use other substances concurrently, increasing the risk of adverse health outcomes. Our aims were to: (i) assess temporal trends in tobacco and/or cannabis use by varying alcohol consumption levels and (ii) identify associated factors of polysubstance use in high-risk alcohol users.

Methods: We conducted a repeated cross-sectional study combining 2010-19 U.S. National Survey of Drug Use and Health (NSDUH). Alcohol consumption was categorized as no use, low-risk use, and high-risk use. Outcomes include past-month tobacco and/or cannabis use, nicotine dependence, and/or frequent cannabis use. We employed linear time trends and multivariable logistic regressions.

Results: We included 395 256 participants aged ≥18 years. From 2010 to 2019, the prevalence of tobacco use and nicotine dependence decreased while that of any and frequent cannabis use increased (P < .05). Tobacco use decreased faster in people with low-/high-risk alcohol use than no use (24% and 22% vs. 16%), whereas any cannabis use increased more rapidly in the no use group (155% vs. 77% in low- and 31% increase in high-risk groups). Among those with high-risk alcohol use, Hispanic individuals were less likely to use tobacco, cannabis, and both tobacco and cannabis, while non-Hispanic Black (NH Black) were more likely to use cannabis and both tobacco and cannabis than NH White counterparts (P < .05).

Conclusion: Past-month tobacco use decreased, while cannabis use increased significantly across all alcohol consumption levels. Sociodemographic subgroups, such as NH Black individuals and those with psychiatric comorbidities, showed increased odds of polysubstance use, underscoring the need for targeted public health interventions.