Co-use of Tobacco Products and Cannabis among Veterans: A Preliminary Investigation of Prevalence and Associations with Mental Health Outcomes

ABSTRACT

While tobacco product (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomatology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of OEF/OIF veterans (N = 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.

KEYWORDS:

• Cannabis
• co-use
• mental health
• military
• nicotine

Acknowledgments

The authors wish to thank Michael Woodward, Jennifer Parker, and the RAND Survey Research Group for this assistance with data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Requests for deidentified data can be made to the senior author at the end of the funding period at https://sites.google.com/usc.edu/thepearl/contact. Requestors will be asked to fill out a data request form, and the data can be used for research purposes only.

Additional information

Funding

This research was funded by grant R01AA026575 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to Eric R. Pedersen (Preventing Alcohol Misuse among Young Adult Veterans through Brief Online Intervention).