Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type
Abstract
:1. Introduction
2. Materials and Methods
2.1. Variables
2.2. Data Analysis
3. Results
3.1. Prevalence of Co-Use, Simultaneous Use, and Mixing
3.2. Likelihood of Co-Use, Simultaneous Use, and Mixing
4. Discussion
4.1. Limitations
4.2. Implications
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Canada | United States—Illegal | United States—Legal | ||||
---|---|---|---|---|---|---|
n | % [95% CI] | n | % [95% CI] | n | % [95% CI] | |
Total Sample | 10,057 | 9714 | 7398 | |||
Sex | ||||||
Female | 5845 | 49.9 [48.7, 51.0] | 5968 | 50.3 [49.1, 51.5] | 4887 | 49.7 [48.2, 51.2] |
Male | 4212 | 50.1 [49.0, 51.3] | 3746 | 49.7 [48.5, 50.9] | 2511 | 50.3 [48.8, 51.8] |
Age Groups | ||||||
16–25 years | 1325 | 18.9 [17.9, 20.0] | 2209 | 19.9 [19.1, 20.8] | 762 | 16.2 [15.0, 17.4] |
26–35 years | 1424 | 20.4 [19.4, 21.5] | 1317 | 21.4 [20.3, 22.6] | 1270 | 25.5 [24.0, 27.0] |
36–45 years | 1538 | 19.3 [18.4, 20.3] | 1484 | 18.9 [17.9, 20.0] | 1268 | 16.9 [15.8, 18.0] |
46–55 years | 2185 | 20.9 [20.0, 21.8] | 1883 | 20.1 [19.2, 21.1] | 1570 | 22.1 [21.0, 23.3] |
56–65 years | 3585 | 20.5 [19.7, 21.2] | 2821 | 19.6 [18.8, 20.4] | 2528 | 19.4 [18.5, 20.3] |
Education | ||||||
Less than High school | 873 | 14.2 [13.2, 15.2] | 1646 | 15.2 [14.5, 16.0] | 358 | 8.2 [7.3, 9.2] |
High school | 1548 | 27.6 [26.4, 28.8] | 1567 | 19.5 [18.5, 20.5] | 1003 | 19.2 [17.9, 20.5] |
Vocational training 1 | 4268 | 33.6 [32.5, 34.6] | 2925 | 38.4 [37.2, 39.7] | 2567 | 46.8 [45.2, 48.3] |
≥Bachelor degree | 3309 | 24 [23.1, 24.8] | 3551 | 26.9 [25.9, 27.9] | 3456 | 25.9 [24.9, 27.0] |
Visible Minority | ||||||
No | 8864 | 86.9 [86.0, 87.7] | 8604 | 81.5 [80.3, 82.6] | 6610 | 86.7 [85.6, 87.8] |
Yes | 1035 | 11 [10.3, 11.8] | 828 | 14 [13.0, 15.1] | 583 | 9.4 [8.5, 10.4] |
Unstated | 158 | 2.1 [1.7, 2.5] | 282 | 4.5 [3.9, 5.2] | 205 | 3.8 [3.2, 4.6] |
Income Adequacy | ||||||
Very difficult | 806 | 8.8 [8.1, 9.5] | 847 | 9.3 [8.6, 10.0] | 554 | 8.4 [7.6, 9.3] |
Difficult | 2000 | 21.1 [20.1, 22.1] | 2107 | 22.2 [21.2, 23.2] | 1423 | 20.8 [19.6, 22.0] |
Neither easy nor difficult | 3593 | 35.8 [34.6, 36.9] | 3016 | 31.6 [30.4, 32.7] | 2443 | 33.3 [31.9, 34.8] |
Easy | 2197 | 20.7 [19.8, 21.6] | 2225 | 22 [21.0, 23.0] | 1715 | 22.4 [21.2, 23.7] |
Very easy | 1183 | 10.3 [9.7, 11.0] | 1330 | 12.9 [12.1, 13.7] | 1118 | 12.7 [11.8, 13.7] |
Don’t know | 131 | 1.9 [1.5, 2.3] | 122 | 1.4 [1.1, 1.7] | 69 | 1.3 [0.9, 1.7] |
Refused | 147 | 1.5 [1.2, 1.8] | 67 | 0.7 [0.5, 0.9] | 76 | 1.1 [0.8, 1.5] |
Past Year Cannabis Use | ||||||
Any | 2413 | 28.3 [27.2, 29.5] | 1997 | 23.8 [22.7, 24.9] | 2344 | 36.8 [35.3, 38.3] |
None | 7644 | 71.7 [70.5, 72.8] | 7717 | 76.2 [75.1, 77.3] | 5054 | 63.2 [61.7, 64.7] |
Dried Herb (smoked or vaped) | 1894 | 23 [21.9, 24.1] | 1641 | 19.2 [18.2, 20.2] | 1760 | 29.1 [27.7, 30.5] |
Cannabis Oils or Liquids—Oral | 576 | 6.4 [5.8, 7.1] | 372 | 4.9 [4.3, 5.5] | 580 | 9.2 [8.3, 10.2] |
Cannabis Oils or Liquids—Vaped | 459 | 6.1 [5.4, 6.7] | 579 | 7.2 [6.5, 7.9] | 813 | 14.4 [13.3, 15.6] |
Edibles/Foods | 1013 | 11.8 [11.0, 12.7] | 727 | 8.8 [8.1, 9.6] | 1278 | 19.9 [18.7, 21.3] |
Beverages | 169 | 2.2 [1.9, 2.7] | 137 | 2.1 [1.7, 2.5] | 294 | 5.8 [5.0, 6.6] |
Concentrates (e.g., wax, shatter, budder) | 357 | 5.1 [4.5, 5.7] | 259 | 3.7 [3.2, 4.2] | 435 | 8.6 [7.7, 9.7] |
Hash or Kief | 537 | 7.2 [6.6, 8.0] | 293 | 4.1 [3.6, 4.7] | 449 | 9.2 [8.3, 10.3] |
Tinctures | 147 | 1.9 [1.6, 2.3] | 126 | 1.6 [1.3, 2.0] | 321 | 5.1 [4.4, 5.9] |
Topical Ointments | 234 | 2.7 [2.3, 3.2] | 215 | 2.7 [2.3, 3.1] | 555 | 8.4 [7.6, 9.4] |
Other | 9 | 0.2 [0.1, 0.5] | 12 | 0.2 [0.1, 0.3] | 4 | 0.1 [0.0, 0.2] |
Past Year Tobacco Use | ||||||
Any | 2377 | 26.7 [25.6, 27.8] | 2321 | 27.1 [25.9, 28.2] | 1571 | 26.1 [24.8, 27.6] |
None | 7676 | 73.3 [72.2, 74.4] | 7390 | 72.9 [71.8, 74.1] | 5823 | 73.9 [72.4, 75.2] |
Tobacco Cigarettes | 2134 | 23.6 [22.6, 24.7] | 1897 | 22.2 [21.1, 23.2] | 1324 | 21.7 [20.4, 23.0] |
E-Cigarettes/Vaped Nicotine | 816 | 9.9 [9.1, 10.7] | 1151 | 13.9 [13.0, 14.8] | 710 | 13.1 [12.0, 14.2] |
Past Year Co-Use of Cannabis & Tobacco | ||||||
Yes | 1154 | 14.5 [13.6, 15.4] | 970 | 12.4 [11.5, 13.3] | 891 | 16.2 [15.0, 17.4] |
No | 8899 | 85.5 [84.6, 86.4] | 8741 | 87.6 [86.7, 88.5] | 6503 | 83.8 [82.6, 85.0] |
Past Year Simultaneous Use of Cannabis & Tobacco | ||||||
Yes | 862 | 10.9 [10.1, 11.7] | 686 | 8.9 [8.1, 9.7] | 625 | 11.6 [10.6, 12.8] |
No | 9195 | 89.1 [88.3, 89.9] | 9028 | 91.1 [90.3, 91.9] | 6773 | 88.4 [87.2, 89.4] |
Past Year Mixing of Dried Herb with Tobacco | ||||||
Yes | 501 | 6.3 [5.7, 6.9] | 265 | 3.7 [3.2, 4.3] | 284 | 5.8 [5.0, 6.7] |
No | 9556 | 93.7 [93.1, 94.3] | 9449 | 96.3 [95.7, 96.8] | 7114 | 94.2 [93.3, 95.0] |
Canada n = 2413 | United States—Illegal n = 1997 | United States—Legal n = 2344 | ||||
---|---|---|---|---|---|---|
% | [95% CI] | % | [95% CI] | % | [95% CI] | |
Past Year Co-Use of Cannabis & Tobacco | ||||||
Yes | 51.2 | [48.8, 53.7] | 52.1 | [49.4, 54.8] | 44.0 | [41.3, 46.6] |
No | 48.8 | [46.3, 51.2] | 47.9 | [45.2, 50.6] | 56.0 | [53.4, 58.7] |
Past Year Simultaneous Use of Cannabis & Tobacco | ||||||
Yes | 38.5 | [36.1, 40.9] | 37.3 | [34.7, 40.0] | 31.6 | [29.1, 34.2] |
No | 61.5 | [59.1, 63.9] | 62.7 | [60.0, 65.3] | 68.4 | [65.8, 70.9] |
Past Year Mixing of Dried Herb with Tobacco | ||||||
Yes | 22.3 | [20.3, 24.4] | 15.7 | [13.7, 17.9] | 15.7 | [13.7, 18.0] |
No | 77.7 | [75.6, 79.7] | 84.3 | [82.1, 86.3] | 84.3 | [82.0, 86.3] |
Co-Use | Simultaneous Use | Mixing | |
---|---|---|---|
aOR [95% CI] | aOR [95% CI] | aOR [95% CI] | |
Jurisdiction | |||
Canada (illegal) | ref | ref | ref |
US (illegal) | 1.1 | 1.02 | 0.60 *** |
[0.95, 1.28] | [0.87, 1.19] | [0.49, 0.73] | |
US (legal) | 0.77 *** | 0.77 ** | 0.56 *** |
[0.66, 0.90] | [0.65, 0.91] | [0.45, 0.70] | |
Cannabis Use Mode (Yes vs. No) | |||
Dried Herb 1 | 1.82 *** | 1.96 *** | |
(smoked or vaped) | [1.54, 2.15] | [1.62, 2.36] | |
Cannabis Oils or Liquids—Oral | 1 | 1.06 | 1.38 ** |
[0.84, 1.18] | [0.89, 1.26] | [1.08, 1.75] | |
Cannabis Oils or Liquids—Vaped | 1.23 ** | 1.22 * | 1.13 |
[1.06, 1.44] | [1.03, 1.43] | [0.91, 1.40] | |
Edibles/Foods | 0.80 ** | 0.73 *** | 0.68 *** |
[0.70, 0.92] | [0.63, 0.84] | [0.56, 0.84] | |
Beverages | 1.05 | 1.02 | 2.01 *** |
[0.82, 1.34] | [0.79, 1.31] | [1.51, 2.66] | |
Concentrates | 1.19 | 1.32 * | 1.12 |
(e.g., wax, shatter, budder) | [0.97, 1.46] | [1.07, 1.62] | [0.85, 1.48] |
Hash or Kief | 1.61 *** | 1.70 *** | 1.55 *** |
[1.34, 1.93] | [1.41, 2.05] | [1.22, 1.97] | |
Tinctures | 0.79 | 0.81 | 0.73 |
[0.60, 1.03] | [0.61, 1.08] | [0.51, 1.05] | |
Topical Ointments | 0.88 | 0.80 * | 1.31 |
[0.71, 1.07] | [0.64, 1.00] | [0.99, 1.73] | |
Age Group | |||
16–25 | ref | ref | ref |
26–35 | 1.08 | 1.26 * | 0.92 |
[0.87, 1.33] | [1.00, 1.59] | [0.69, 1.21] | |
36–45 | 1.32 * | 1.77 *** | 0.93 |
[1.06, 1.64] | [1.41, 2.23] | [0.70, 1.23] | |
46–55 | 1.15 | 1.72 *** | 0.55 *** |
[0.93, 1.43] | [1.37, 2.16] | [0.41, 0.74] | |
55–65 | 0.73 ** | 1.04 | 0.33 *** |
[0.60, 0.90] | [0.84, 1.30] | [0.25, 0.45] | |
Sex | |||
Male | 1.20 ** | 1.11 | 1.42 *** |
[1.06, 1.36] | [0.97, 1.26] | [1.19, 1.70] | |
Education | |||
<High school | ref | ref | ref |
High school graduate | 1.1 | 1.19 | 1.21 |
[0.86, 1.40] | [0.92, 1.54] | [0.85, 1.73] | |
Vocational Training 1 | 1.06 | 1.06 | 1.53 ** |
[0.84, 1.33] | [0.83, 1.35] | [1.11, 2.10] | |
≥Bachelor’s degree | 0.68 ** | 0.65 ** | 1.80 *** |
[0.53, 0.86] | [0.51, 0.84] | [1.30, 2.50] | |
Visible Minority | |||
Yes | ref | ref | ref |
No (White) | 1.22 | 0.95 | 0.94 |
[0.97, 1.53] | [0.75, 1.21] | [0.69, 1.27] | |
Income Adequacy | |||
Very Difficult | ref | ref | ref |
Difficult | 1.14 | 1.08 | 0.86 |
[0.90, 1.46] | [0.84, 1.38] | [0.60, 1.23] | |
Neutral | 0.86 | 0.88 | 0.97 |
[0.68, 1.08] | [0.69, 1.12] | [0.69, 1.37] | |
Easy | 0.84 | 0.91 | 0.96 |
[0.65, 1.08] | [0.70, 1.18] | [0.67, 1.38] | |
Very Easy | 0.76 | 0.72 * | 1.60 * |
[0.58, 1.00] | [0.54, 0.97] | [1.09, 2.34] |
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Chu, A.; Chaiton, M.; Kaufman, P.; Goodwin, R.D.; Lin, J.; Hindocha, C.; Goodman, S.; Hammond, D. Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type. Int. J. Environ. Res. Public Health 2023, 20, 4206. https://doi.org/10.3390/ijerph20054206
Chu A, Chaiton M, Kaufman P, Goodwin RD, Lin J, Hindocha C, Goodman S, Hammond D. Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type. International Journal of Environmental Research and Public Health. 2023; 20(5):4206. https://doi.org/10.3390/ijerph20054206
Chicago/Turabian StyleChu, Alanna, Michael Chaiton, Pamela Kaufman, Renee D. Goodwin, Jodie Lin, Chandni Hindocha, Samantha Goodman, and David Hammond. 2023. "Co-Use, Simultaneous Use, and Mixing of Cannabis and Tobacco: A Cross-National Comparison of Canada and the US by Cannabis Administration Type" International Journal of Environmental Research and Public Health 20, no. 5: 4206. https://doi.org/10.3390/ijerph20054206