Illinoisan Adolescent Use of Cannabis, Electronic Cigarettes, and Combustible Tobacco

Objectives: Our study aims to identify social and behavioral factors associated with the sole-, dual-, and poly-substance use of cannabis, electronic cigarettes (ECs), and combustible tobacco among Illinoisan adolescents during the period when medical and recreational marijuana use have both been legalized. Study Design: Cross-Sectional Methods: Data came from the 2022 Illinois Youth Survey (IYS, administered to 8th-, 10th-, and 12th-grade adolescents). Multinomial regression models were used to estimate the associations between social, environmental, and behavioral characteristics and substance use patterns of sole-, dual-, and poly-substance use. Results: Approximately 14% of Illinoisian adolescents indicated past 30 days ever-use of the substances cannabis, ECs, or combustible tobacco. Over 80% of ever-users, used cannabis and ECs. After adjusting for demographics, self-reported depression (RRs: 1.88, 2.23, 2.25), being bullied at school (RRs: 1.34, 1.53, 1.50), self-perceived campus being unsafe (RRs: 1.20, 1.39, 1.89), having peer pressure (RRs: 1.68, 1.69, 1.79), and alcohol use (RRs: 6.99, 13.11, 34.25) were significantly associated with higher odds of sole-, dual-, and poly-substance use, respectively, compared with no substance use at all. Participating in structured sports (RRs: 0.93, 0.87), having family rules on substance use (RRs: 0.76, 0.67, 0.58), living in rural areas (RR: 0.79, 0.77, 0.57), and living in more economically affluent areas significantly reduced the odds of sole-, dual-, and poly-substance use, respectively. Conclusions: Our study identified several social, environmental, and behavioral factors associated with adolescent substance use. Findings can help inform program designs, prevention strategies, and clinical screening to tackle adolescent substance use.