Multilevel Correlates of Same Day Poly-product Use/Co-use among Adolescents Who Use Tobacco and Cann

Jacobs W, Qin WA, Jafarzadeh NS, Barrington-Trimis J, Leventhal AM.
Multilevel Correlates of Same Day Poly-product Use/Co-use among Adolescents Who Use Tobacco and Cannabis
Nicotine Tob Res. 2025 Dec 23;28(1):26-35. doi: 10.1093/ntr/ntaf150. PMID: 40684795; PMCID: PMC12723218.

Introduction: Polysubstance use-use of more than one substance-is prevalent and an emergent public health issue. Yet not much is known about factors associated with same-day polysubstance use among adolescents. This study examined correlates of same-day tobacco and cannabis use/co-use among adolescents who use tobacco/cannabis.

Methods: Cross-sectional data were from 10th and 11th grade students (n = 536) who reported tobacco/cannabis use. Regression models were used to examine intrapersonal, psychological (anxiety, depression), societal (societal concern, discrimination), and environmental (public and home secondhand smoke/vape exposure) correlates of past 30-day usage frequency (no, infrequent, and frequent use) of same-day: poly-product use (poly-tobacco/nicotine [use of different types of nicotine/tobacco]; poly-cannabis [use of different types of or marijuana/tetrahydrocannabinol (THC)]); poly-drug use [tobacco/nicotine and marijuana/THC], and nicotine and THC vape mixing.

Results: Participants were predominantly Hispanic (66.23%) and male (62.50%). Among participants, 8.58%, reported frequent same-day poly-tobacco use, 13.81% frequent same-day poly-cannabis use, 13.25% frequent same-day poly-drug use, and 3.36% vape mixing. Past 30-day alcohol use was associated with higher odds (1.88-8.31, p<.05) of infrequent and frequent same day use of all study outcomes except vape mixing. Secondhand smoke/vapor exposure was consistently associated with higher odds (1.13-1.26, p < .05) of infrequent/frequent same day use. Discrimination increased the odds of some same-day polysubstance use while societal concerns had inconsistent effects across study outcomes.

Conclusion: A significant proportion of adolescents who use tobacco/cannabis products might engage in high-risk use patterns. Alcohol use, societal, and environmental factors significantly increase the likelihood of same-day poly-use of tobacco and cannabis products.

Implications: Frequent same-day poly-product/drug use is common among adolescents who use tobacco and/or cannabis. Alcohol use, societal concerns, and environmental exposure to secondhand smoke/vape are significant contributors to same-day poly-product/drug use and nicotine and marijuana/THC vape mixing among these adolescents. Findings suggest that while infrequent same-day poly-product/drug use may be more opportunistic and situation-dependent, often occurring in contexts where alcohol is present, frequent use may be more influenced by social contexts and environmental cues. Understanding these complex relationships between substances and high-risk use patterns is crucial for developing effective prevention strategies and treatment approaches for poly-drug use disorders.