Dual nicotine and cannabis use among Asian American and Pacific Island adults: the role of anxiety and negative reinforcement expectancies on nicotine outcomes

Background There are documented health disparities concerning Asian American and Pacific Island (AAPI) adults who smoke combustible tobacco, yet little work has identified factors related to worse smoking outcomes among these individuals. This is the first study to test whether cannabis use among AAPI adults who smoke tobacco is related to more severe cigarette dependence, and whether negative affect and negative reinforcement expectancies play a role in those relations.Method The current study tested this among AAPI adults (N = 530; 42.8% female, aged 18–75) who endorsed current tobacco smoking and completed an online survey.Results Participants who used cannabis (i.e. nicotine-cannabis dual use) were more likely to be born in the U.S. and reported more anxiety, depression, cigarettes per day (CPD), cigarette dependence, barriers to smoking cessation, and negative consequences and negative reinforcement smoking outcome expectancies. The relations of nicotine-cannabis dual use status with cigarette dependence and barriers to cessation occurred indirectly via anxiety (not depression). The relations of dual use status with CPD, dependence severity, and perceived barriers to cessation occurred indirectly via negative reinforcement expectancies. The relations of dual use with all three smoking outcomes also occurred via anxiety’s relation with negative reinforcement expectancies and negative reinforcement expectancies’ relations with smoking outcomes.Conclusions Results highlight several clinical correlates of cannabis dual use among AAPI adults who smoke combustible tobacco cigarettes and suggest that anxiety and the expectation that smoking may help manage such negative emotions may play important roles in smoking processes among this group.