Binge Drinking, Cannabis, and Tobacco Use and Modifiable Social Risks Among Adults Who Used Health Care

Background Screening for certain types of substance use is common in health care. Screening for social risks—modifiable social conditions affecting health—is less common. Understanding how binge drinking, cannabis use, and tobacco use co-occur with social risks could inform interventions targeting these factors simultaneously. Objective Examine the relationship between binge drinking, tobacco, and cannabis use and social risks among US health care users. Design Retrospective population-based cross-sectional study. Participants Adults from 15 US states or territories who participated in the 2022 Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System survey and had a health care visit in the past 2 years ( N = 76,891). Main Measures Social risks included employment loss/reduction, receipt of food stamps, difficulty paying for food, inability to pay bills, threat of utility shutoff, and lack of reliable transportation. Exposures were the presence and frequency of past-month binge drinking, cannabis use, or nicotine product use. We assessed rates of modifiable social risks by substance use variables and calculated marginal effects adjusting for age, sex, race/ethnicity, and education. Key Results Overall, 30.9% reported at least one social risk. Difficulty paying for food was the most common (12.4%). The adjusted prevalence of having any social risks was elevated among individuals with past-month cannabis or tobacco use (e.g., 42.1% and 42.6%, respectively), but not among those with past-month binge drinking (29.3%). However, individuals with daily binge drinking, cannabis use, or tobacco use had substantially increased social risks. The probability of experiencing social risks increased with the number of substances used. Limitations A cross-sectional survey. Conclusions Cannabis and tobacco may signal underlying social risks, even at low frequency. Binge drinking was associated with social risks only when it occurred daily. Future research should determine whether addressing substance use can reduce social risks, and vice versa, within integrated health care services.