Heterogeneity in Nicotine, Tobacco, and Cannabis Use Among U.S. Adolescents and Adults Aged 12–34 Years

Introduction

Nicotine, tobacco, and cannabis use continues to evolve in the U.S., with new forms of use (e.g., oral nicotine, cannabis edibles) emerging and increasing. It is critical to understand how these substances are being used and co-used. This study identified subgroups of adolescents and younger adults aged 12–34 years on the basis of nicotine, tobacco, and cannabis use using recent nationally representative data.

Methods

Cross-sectional data from the Population Assessment of Tobacco and Health Wave 7 (2022–2023) were used. Analyses focused on those aged 12–34 years who reported any past 30-day nicotine, tobacco, or cannabis use (n=8,722). Latent class analysis was conducted using 8 indicators: combustible tobacco use, nicotine vaping, oral nicotine product use, other noncombustible tobacco use (e.g., snus/chew), blunt use, cannabis smoking, cannabis vaping, and cannabis edibles. Differences were examined by sex, age, race, ethnicity, and region.

Results

On average, individuals reported use of approximately 2 products in the past 30 days (mean=2.08). Six subgroups of nicotine, tobacco, and cannabis use were identified: combustible tobacco (30.77%), multimodal cannabis (26.72%), vaping nicotine (18.37%), multimodal co-use (13.87%), cannabis edibles (5.31%), and multimodal nicotine/tobacco (4.95%). Sociodemographic characteristics were associated with class membership.

Conclusions

There is substantial heterogeneity in nicotine, tobacco, and cannabis use among U.S. adolescents and younger adults. Of particular concern is that most of the sample reported combustible use, including 3 subgroups that reported multiple modes of use. Continued surveillance of nicotine, tobacco, and cannabis use is needed, particularly as the products and their regulation continue to evolve.