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Measuring combined tobacco, e-cigarette, and marijuana use

Institution: University of California, San Francisco
Investigator(s): Danielle Ramo, Ph.D. Dorothy Apollonio, Ph.D.
Award Cycle: 2016 (Cycle 25) Grant #: 25IR-0025 Award: $374,448
Subject Area: Tobacco-Related Health Disparities
Award Type: High Impact Research Project Award

Initial Award Abstract
This project will identify the relationships among, predictors of, and attitudes toward tobacco, marijuana, and electronic cigarette ("e-cigarette") co-use in youth and young adult Californians over time. Our central hypothesis is that patterns of co-use will increase over time and be associated with specific modes of administration and favorable attitudes toward deregulation of e-cigarettes and marijuana. As companies promote new smoking devices that can easily be used for both tobacco with marijuana (e.g., e-cigarettes, vaporizers), youth and young adults may be more prone to using both drugs. Unfortunately, adequately powered epidemiological studies with national and state-level datasets fail to include assessments of simultaneous use. This makes it difficult to gauge the changing prevalence and risks to the public health of Californians. Policymakers need such information when deliberating major policy changes, including the regulation of e-cigarettes and the legalization of recreational marijuana use, the latter likely to be a ballot initiative in 2016. Our long-term goal is to provide knowledge needed to develop evidence-informed policy for e-cigarettes and marijuana, especially as it relates to youth and young adults. We draw on five annual waves of California data from the National Survey on Drug Use and Heath (NSDUH), 2010-2014, two waves of data from the online California Adult Tobacco Survey (CATS) and Behavioral Risk Factor Surveillance System (BRFSS), 2017-2018, and original items added to the 2017 California Health Interview Survey (CHIS). Analyses will be conducted separately for adolescents (age 12 to 17) and young adults (age 18 to 25) and will examine trends in combined tobacco and marijuana use over the periods between 2010 to 2014 and 2016 to 2017, prevalence of simultaneous use in 2017, and changes in attitudes toward marijuana and e-cigarette regulatory policy between 2016 and 2017. Proposed specific aims are: Specific Aim 1. To examine trends in tobacco and marijuana co-use and simultaneous use among adolescents and young adults in California, through the period immediately preceding and following decriminalization of marijuana possession (2010-2014) and a ballot initiative to legalize recreational marijuana use (2016-2017). Specific Aim 2. To evaluate prevalence of dual tobacco and marijuana use and determine how it is related to modes of tobacco and marijuana ingestion (e.g., smoking, blunt use, vaping, eating) among California's youth and young adults. Specific Aim 3. To examine changes in attitudes toward marijuana policies among young adults before and after a ballot initiative to legalize recreational use. Findings could assist policymakers in the implementation of regulations, and inform treatment and prevention planning with young people. We hope to inform the limited research literature on whether recreational legalization of marijuana may undermine some functions of tobacco control policy in California.