A cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to determine if tobacco and cannabis methods of administration are likely to be consistent across products

Cannabis and tobacco co-use has increased over time, but research evaluating co-use risks rarely considers different cannabis or tobacco use modalities (e.g., smoking, vaping). Data were analyzed from 4,071 participants from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey, a nationally representative survey of United States adults, who endorsed past 30-day cannabis use and current cigarette smoking and/or vaping. A weighted multinomial logistic regression was used to determine if current tobacco use (cigarettes, vaping, or dual use; independent variable) was associated with cannabis use modality (only smoking, only vaping, or smoking and vaping cannabis; dependent variable), controlling for race, sex, and education level. Compared to individuals who smoked cigarettes, those vaping (odds ratio [OR] = 7.12, 95% confidence interval [CI]: 4.03, 12.58) or dual using (OR = 5.69, 95% CI: 2.66, 12.19) tobacco were more likely to vape cannabis than smoke cannabis. Additionally, compared to those who smoked cigarettes, individuals vaping (OR = 3.77, 95% CI: 2.73, 5.19) or dual using (OR = 4.62, 95% CI: 3.21, 6.64) tobacco were more likely to smoke and vape cannabis than exclusively smoke cannabis, but were less likely to smoke and vape cannabis than exclusively vape cannabis (OR = 0.53, 95% CI: 0.29, 0.97). Race and education level differences were also found. Results indicated adults co-using tobacco and cannabis may use the same consumption modality for both products (e.g., those smoking tobacco also smoke cannabis, while those vaping tobacco also vape cannabis), which has important implications for health risks.