Shannon Gravely1, Pete Driezen2, Danielle M Smith3, Ron Borland4, Eric N Lindblom5, David Hammond6, Ann McNeill7, Andrew Hyland3, K Michael Cummings8, Gary Chan9, Mary E Thompson10, Christian Boudreau10, Nadia Martin11, Janine Ouimet11, Ruth Loewen11, Anne C K Quah11, Maciej L Goniewicz3, James F Thrasher12, Geoffrey T Fong13. 1. Department of Psychology, University of Waterloo, Waterloo, Canada. Electronic address: shannon.gravely@uwaterloo.ca. 2. Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. 3. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States. 4. School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Cancer Council Victoria, Melbourne, VIC, Australia. 5. O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, DC United States. 6. School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. 7. King's College London, Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; UK Centre for Tobacco & Alcohol Studies, Nottingham, United Kingdom. 8. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, United States. 9. Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia. 10. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada. 11. Department of Psychology, University of Waterloo, Waterloo, Canada. 12. Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States; Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. 13. Department of Psychology, University of Waterloo, Waterloo, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; Ontario Institute for Cancer Research, Toronto, Canada.
Abstract
BACKGROUND: Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization. METHODS: Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England. RESULTS: Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%). CONCLUSION: Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.
BACKGROUND: Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization. METHODS: Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England. RESULTS: Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%). CONCLUSION: Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.
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