Cannabis Use and Subsequent CIGARETTE Discontinuation among U.S. Adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1-5

Abstract Introduction This study examined the association between the current co-use of cannabis and cigarettes in the past 30 days and subsequent cigarette discontinuation (past 30-day point-prevalence abstinence) among U.S. adults with established cigarette use in the Population Assessment of Tobacco and Health (PATH) Study. Additionally, we investigated the impact of co-use on the subsequent discontinuation of all combustible tobacco products. Aims and Methods A total of 26 381 observations contributed by 8218 adults with established cigarette use (ie, smoked ≥100 cigarettes in their lifetime, and currently smoking cigarettes every day or some days) from waves 1–5 of the PATH Study were included in the analysis. Weighted generalized estimating equations (GEE) models were used to evaluate the association between current co-use at baseline (waves 1–4) with the outcomes assessed at the subsequent wave (cigarette and combustible tobacco discontinuation at waves 2–5). Final models included: Demographic characteristics (age, sex, race and ethnicity, and educational attainment), behavior characteristics (intention to quit, internalizing symptoms, externalizing symptoms, and substance use problems), and wave-pair. Results Over one-third (35.91%) of the adults currently smoking cigarettes self-reported co-use during the study period. Cannabis use among adults with established cigarette use increased over time. Co-use was associated with decreased odds of cigarette smoking discontinuation at follow-up, after adjusting for covariates (aOR: 0.81; 95% CI: 0.72, 0.93; p = .0018). Similar effect sizes were observed for the discontinuation of all combustible tobacco products (aOR: 0.75; 95% CI: 0.65, 0.86; p .0001). Conclusions Cannabis use among adults with established cigarette use was inversely related to subsequent cigarette discontinuation, suggesting that co-use may reduce the likelihood of successful tobacco cessation. Implications Findings demonstrate that cannabis use may lead to lower odds of discontinuation among adults with established cigarette use; therefore, individuals who co-use cigarettes and cannabis may need additional tobacco cessation support. Notably, this study observed an increase in the co-use of cigarettes and cannabis, emphasizing the need for researchers and public health programs to shift their focus toward understanding and addressing concurrent substance use among adults who smoke cigarettes.