Heterogeneity in nicotine, tobacco, and cannabis use among US adolescents and adults, ages 12-34 years

Nicotine, tobacco, and cannabis use continues to evolve in the US with new forms of use (e.g., oral nicotine, cannabis edibles) emerging and increasing. It is critical to understand how these substances are being used and co-used. This study identified subgroups of adolescents and younger adults ages 12 to 34 years based on nicotine, tobacco, and cannabis use using recent nationally-representative data. Cross-sectional data from the Population Assessment of Tobacco and Health Wave 7 (2022/23) was used. Analyses focused on those ages 12-34 years who reported any past 30-day nicotine, tobacco, or cannabis use (n=8,722). Latent class analysis was conducted using eight indicators: combustible tobacco use, nicotine vaping, oral nicotine product use, other noncombustible tobacco use (e.g., snus/chew), blunt use, cannabis smoking, cannabis vaping, and cannabis edibles. Differences were examined by sex, age, race, ethnicity, and region. On average, individuals reported use of approximately two products in the past 30 days (M=2.08). Six subgroups of nicotine, tobacco, and cannabis use were identified: Combustible Tobacco (30.77%), Multimodal Cannabis (26.72%), Vaping Nicotine (18.37%), Multimodal Co-Use (13.87%), Cannabis Edibles (5.31%), and Multimodal Nicotine/Tobacco (4.95%). Sociodemographic characteristics were associated with class membership. There is substantial heterogeneity in nicotine, tobacco, and cannabis use among US adolescents and younger adults. Of particular concern is that most of the sample reported combustible use, including three subgroups that reported multiple modes of use. Continued surveillance of nicotine, tobacco, and cannabis use is needed, particularly as the products and their regulation continue to evolve.