Tobacco and marijuana co-use behaviors among cigarillo users

Objectives: In this study, we examine the frequency of ‘simultaneous use’ (smoking tobacco in close temporal proximity to smoking marijuana) and substitution (smoking a cigarillo in place of a marijuana blunt – a cigar wrapper filled with marijuana) and their association with nicotine dependence (ND) among young cigarillo users. Methods: The sample consisted of 686 cigarillo and blunt co-users who responded to a cross-sectional, Web-based survey of 14-28-year-olds recruited via social media. We used bivariate analyses and multiple linear regression to examine the association of simultaneous use and substitution with participant demographics, tobacco product use, marijuana use, and ND. Results: Most users reported simultaneous use (72.4%) and substitution (67.9%). Chasing was the most common form of simultaneous use (63%). Simultaneous users were more likely to use tobacco daily and to smoke cigarettes, and reported a lower age of initiation to marijuana and tobacco than non-simultaneous users. The most common rea-son for substituting (73%) was the lack of availability of marijuana. Both practices were strongly and independently associated with greater ND, adjusting for covariates. Conclusions: Simultaneous use and substitution are common co-use behaviors among cigarillo users, and may play a role in promoting increased tobacco use and nicotine dependence.