Tobacco and cannabis co-use by sexual minority adults in the United States, 2022

Introduction: Given the negative health outcomes of tobacco and cannabis co-use, understanding the co-use of tobacco and cannabis is important, particularly regarding those with higher health burdens, such as sexual minority individuals. This study examined the co-use of tobacco and cannabis by sexual identity.

Methods: The adult sample from the 2022 National Survey on Drug Use and Health (NSDUH) was used for this study. A multinomial logistic regression was performed on past-month tobacco and cannabis use (i.e., no use of tobacco and cannabis [reference], tobacco only use, cannabis only use, tobacco and cannabis co-use) by sexual identity (i.e., heterosexual (reference), gay/lesbian, bisexual), adjusting for demographics. Data were collected in 2022, and statistical analyses were performed in 2024.

Results: Among the overall adult sample, 15.8% (weighted) reported past-month tobacco only use, 7.4% reported past-month cannabis only use, and 8.5% reported past-month tobacco and cannabis co-use. Among female adults, tobacco and cannabis co-use was more likely to be reported by lesbian females (aRRR=3.83, 95% CI=2.51, 5.84) and bisexual females (aRRR=6.48, 95% CI=5.17, 8.11), compared with heterosexual females. Among male adults, tobacco and cannabis co-use was more likely to be reported by gay males (aRRR=1.68, 95% CI=1.05, 2.68) and bisexual males (aRRR=1.94, 95% CI=1.42, 2.66), compared with heterosexual males.

Conclusions: This study observed high levels of tobacco and cannabis co-use among sexual minority individuals. Future research should examine factors that influence tobacco and cannabis co-use for sexual minority individuals.