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Patterns in U.S. states with legalized nonmedical adult use
Watkins, S. L., Thompson, J., Feld, A. L., Ling, P. M., & Lee, Y. O. (2023). Flavored cannabis use and cannabis-tobacco co-use: Patterns in U.S. states with legalized nonmedical adult use. American Journal of Preventive Medicine, 65(4), 551-559. https://doi.org/10.1016/j.amepre.2023.05.006
INTRODUCTION: Little is known about inhaled flavored cannabis use. This study aimed to investigate the prevalence and patterns of flavored cannabis use and cannabis-tobacco co-use.
METHODS: This study surveyed adult past 30-day cannabis users in US states and districts that have legalized cannabis for non-medical/adult use (n=9) (November 2018; n=2,978). By product/behavior (any cannabis, cannabis extract vaporizers, mixed cannabis-nicotine vaporizers, blunts, chasing) the association between flavored (vs. non-flavored) use and sociodemographic characteristics, cannabis use disorder symptoms, and tobacco use was estimated using weighted multivariable logistic regression in January, 2022.
RESULTS: Almost half of adult cannabis users reported using at least one flavored cannabis product (46.5%). Flavored cannabis use was more likely among respondents who were female (AOR: 1.2; CI: 1.0, 1.4), Black (ref: White; AOR: 2.2; CI: 1.5, 3.1), Hispanic/Latinx (ref: White; AOR: 1.6; CI: 1.2, 1.9), had cannabis use disorder symptoms (AOR: 2.0; CI: 1.6, 2.4) or current tobacco use (AOR: 2.4; CI: 2.1, 2.9). Use was less likely among middle-aged/older adults (ref: 21-34 vs. 35-49; AOR: 0.6; CI: 0.5, 0.7).
CONCLUSIONS: Observed differences in flavored cannabis use are concerning if flavors raise appeal or dependence. Integrating flavored cannabis and tobacco research and practice is warranted.