Sessions, Cyphers, and Parties

Blunt smoking during emerging adulthood: Characterizing transitions in cannabis and cigar co-use among a diverse cohort in Texas

OBJECTIVE

To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021.

METHODS

We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking.

RESULTS

At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21-3.84) and Hispanic (HR: 1.72; 95% CI: 1.08-2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16-2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42-0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40-19.45), NHB (HR: 3.14; 95% CI: 1.32-7.46), and Hispanic (HR: 2.99; 95% CI: 1.80-4.97) participants.

CONCLUSIONS

Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people.

Race, psychosocial characteristics, and treatment outcomes among individuals undergoing treatment for cannabis use disorder: A latent profile analysis based on preferred method of using cannabis

INTRODUCTION

There are a wide variety of methods for using combustible cannabis which may impact an individual's pattern of use as well as their response to cannabis use disorder (CUD) treatment. Previous research has noted racial/ethnic differences in cannabis users' preferred method of use.

METHOD

The current study examined data from a randomized placebo-controlled trial of a pharmacological intervention for adults with CUD. Latent profile analysis classified participants (N = 302) based on their primary method of combustible cannabis use.

RESULTS

A four profile solution emerged which identified participants who demonstrated 1) Primarily Joint (n = 50), 2) Primarily Blunt (n = 106), 3) Mixed MoU (n = 30), and 4) Primarily Pipe (i.e., pipe or bong; n = 116) use. Profiles were compared on socio-demographic characteristics and racial differences were found among the four latent profiles as well as differences in their level of use. Cannabis users with a preference for joints were more likely to be White as compared to other racial groups. In contrast, a greater proportion of participants with a preference for blunts were African American. The Primarily Joint profile was found to have the highest cannabis relapse rate at 1-month follow-up (94%) which was significantly greater than the Mixed MoU (74%, x² = 5.06, p < .05) and Primarily Pipe (78%, x² = 9.24, p < .01) profiles. Interestingly, there was no difference in 1-Month Follow-up cannabis relapse rates between the Primarily Joint and Blunt profiles (87%, x² = 9.24, p > .05).

CONCLUSIONS

Findings suggest that treatment-seeking individuals who primarily use joints or blunts may face unique challenges that may impact cannabis abstinence. Along with other cannabis-related characteristics, an individual's preferred method of use may represent an important factor to consider in the treatment of CUD.

Prevalence and correlates of daily blunt use among U.S. African American, Hispanic, and White adults from 2014 to 2018

OBJECTIVE

Blunt smoking presents unique public health concerns relative to other methods of marijuana use, including greater exposure to toxins and carcinogens as well as increased risk for cannabis use disorder. This study examines correlates of self-reported daily blunt use among a nationally representative sample of adult blunt users in the United States.

METHOD

We pooled and analyzed 5 years of cross-sectional data from n = 10,826 adult blunt smokers in the United States using the National Survey on Drug Use and Health (2014-2018). Multiple logistic regression analysis examined correlates of daily blunt use among non-Hispanic White, non-Hispanic African American, and Hispanic/Latino adult blunt users in the United States. Next, multiple logistic regression analyses stratified by race/ethnicity were conducted. This study examined: (a) socio-demographic (age, sex, and income); (b) behavioral (alcohol, tobacco, and illicit drug use); (c) intrapersonal (depression); and (d) regulatory (marijuana laws) factors.

RESULTS

African Americans had the greatest prevalence of daily blunt use (24.2%), relative to Whites (9.1%) and Hispanic/Latinos (13.9%) (p < .001). African Americans aged 26-34 years old (adjusted odds ratio [Adj OR]: 1.37) and living in medical marijuana states (Adj OR: 1.28) were more likely to be daily blunt users; these factors were not associated with daily blunt use in the full sample or in stratified models of Whites or Hispanic/Latinos. Alcohol use was negatively associated with daily blunt use among Whites and Hispanic/Latinos but not African Americans.

CONCLUSIONS

Socio-demographic, behavioral, and regulatory factors appear differently associated with daily blunt use across racial/ethnic groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Is it "loud" enough?: A qualitative investigation of blunt use among African American young adults

Heavy blunt use is common among young adult cannabis users, especially African Americans. This exploratory qualitative study aimed to examine how African American young adults understand, talk about and experience their blunt use. Semi-structured interviews were conducted with adults reporting daily or almost daily blunt use in the past month (N = 20; 75% male). Thematic analysis of the audio-recorded interviews revealed aspects of how blunts are described, made and used among heavy blunt users. The three emergent themes have implications for the assessment of cannabis use and intervention development for heavy blunt users.

Blunt and Non-Blunt Cannabis Use and Risk of Subsequent Combustible Tobacco Product Use Among Adolescents

INTRODUCTION

Cannabis-including blunts (cannabis rolled in tobacco-containing cigar casing) -is commonly the first substance used among adolescents and may increase the likelihood of subsequent initiation of combustible tobacco products.

AIMS AND METHODS

Data were pooled from two prospective studies of adolescents in California and Connecticut (total N = 4594). Logistic regression models assessed the association of baseline ever blunt use and ever non-blunt cannabis use (vs. never cannabis use) with subsequent initiation of any combustible tobacco-only product (ie, cigarettes, cigars, or cigarillos) by 1-year follow-up after adjustment for demographic characteristics and other tobacco product use at baseline. We also assessed whether estimates differed by prior e-cigarette or hookah use at baseline.

RESULTS

Among never combustible tobacco-only product users (N = 2973), 221 (7.4%) had ever used a blunt and 114 (3.8%) had ever used only non-blunt cannabis at baseline. Blunt use (adjusted odds ratio [AOR] = 1.98, 95% confidence interval [CI]: 1.30 to 3.01) and non-blunt cannabis use (AOR = 2.38, 95% CI: 1.41 to 4.00) were independently associated with greater odds of combustible tobacco-only product initiation by follow-up. Among those who had not tried e-cigarettes or who had not tried hookah, blunt use and non-blunt cannabis use were associated with significantly increased odds of combustible tobacco product initiation; among those who had tried e-cigarettes or hookah, the association was not significant.

CONCLUSIONS

We found blunt and non-blunt cannabis use to be associated with subsequent combustible tobacco-only product initiation, particularly among adolescents who had not also tried other products containing nicotine.

IMPLICATIONS

Adolescent-focused tobacco prevention efforts should consider incorporating cannabis products, including blunts. More research is needed to understand how blunt use and cannabis use more broadly are associated with initiation of tobacco products.

Does Starting to Smoke Cigars Trigger Onset of Cannabis Blunt Smoking?

Introduction

Among United States teens during the 1990s, increasing cigar use coincided with increasing use of tobacco cigar shells filled with cannabis, called "blunts." Cigar smokers are more likely to use cannabis, and we hypothesized that starting to smoke cigars might be a probabilistic "trigger" of blunt smoking. We turned to the case-crossover approach to evaluate this hypothesis.

Methods

Within US National Surveys on Drug Use and Health, 2009-2013, we identified a nationally representative sample of newly incident blunt smokers aged 12- to 21-years-old (n = 4868) and compared month-of-onsets for smoking of cigars and blunts. Using the subjects-as-their-own-controls case-crossover design, we specified the first month prior to blunt use as a "hazard interval" and the second month prior to blunt use as a "control interval." We used Mantel-Haenszel (MH) estimators to estimate the matched-pairs odds ratio (OR).

Results

The MH OR estimate was 1.7 (95% CI = 1.3, 2.3), with excess odds of cigar onsets during the hazard interval relative to the control interval. Two alternative control interval specifications yielded congruent estimates (OR = 2.7 and 2.9, respectively).

Conclusions

A short interval right after starting to smoke cigars may be one of increased risk of starting to smoke blunts. We discuss cigar, cigarillo, and "blunt wraps" control approaches that might reduce both tobacco and cannabis-related harms.

Implications

If this evidence is correct, increased market-targeting to promote youthful cigar and cigarillo smoking might be followed by increased rates of blunt smoking in a vulnerable population. As noted by others, enhanced risk of smoking-attributable harms might be a consequence of mixed tobacco-cannabis formulations.

Understanding Nicotine Dependence and Addiction Among Young Adults Who Smoke Cigarillos: A Qualitative Study

Introduction

Cigarillo use is increasing, particularly among young adults. Nicotine dependence (ND) is important for understanding smoking behavior and cessation, but the development of measures of ND has focused almost exclusively on cigarette smokers. We examined smoking patterns, preferences, and beliefs of cigarillo users to better understand their experience of addiction and expression of ND symptoms.

Methods

Using purposive sampling, we conducted in-depth interviews between June 2015 and January 2016 with 30 young adults aged 18-28 who reported smoking ≥1 cigarillo per week. Interviews were based on a semi-structured guide designed to capture participants' smoking levels and patterns as well as their experiences of smoking and addiction. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes.

Results

Participants had a mean age of 23, with a majority being female (56%) and African American (80%). The median number of cigarillos smoked per week was 20; 70% also smoked cigarettes, and 43% also smoked marijuana blunts. Our analysis highlighted the complexity of measuring cigarillo use due to product manipulation, sharing, and multiple product use. Participants expressed a preference for smoking in a social group where cigarillos were shared, and not smoking an entire cigarillo at once when alone. Most cigarillo users did not consider themselves to be addicted.

Conclusions

Cigarillo users express unique smoking practices and beliefs that signify the need for a more product-inclusive measure of ND, and can inform the development of tobacco cessation interventions tailored to cigarillo users.

Implications

The increasing use of cigarillos among young adults has significant public health consequences. Addressing this issue requires accurate measurement and effective treatment of dependence on cigarillo products. The results of this study directly inform the development of a revised measure of ND, and can contribute to the efficacy of cessation interventions for cigarillo users.

Puff, puff, drink: The association between blunt and alcohol use among African American adolescents and young adults

Although African Americans report lower levels of alcohol use relative to their White counterparts, they experience higher rates of alcohol-related problems (e.g., alcohol dependence). One understudied connection between alcohol use and dependence is the dual use of illicit drugs, especially marijuana use. It is speculated that blunt use in combination with alcohol will have more adverse alcohol-related consequences among African Americans than alcohol use alone or alcohol and nonblunt marijuana use. The current study uses pooled data from the 2011-2014 National Survey on Drug Use and Health to examine the odds of alcohol dependence based on alcohol and marijuana typology in comparison to alcohol only users. Among 11,124 African American adolescents (12-17) and young adults (18-25) who consumed alcohol in the past year, 57.5%, 36.8%, and 5.7% reported alcohol use alone and in combination with blunt use and nonblunt marijuana use, respectively. Relative to alcohol users only, youth who used alcohol and blunts had increased odds of having alcohol dependence. This association was not found among youth who reported alcohol and nonblunt marijuana use. The increased rates of alcohol dependence highlight the public health concern of dual alcohol and a specific type of marijuana use (i.e., blunts) among African American youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Blunt Use among Adolescents and Young Adults: Informing Cigar Regulations

Objectives

We used focus groups to understand cigar product features that increase the appeal of blunts (hollowed out cigars filled with marijuana) among adolescents and young adults.

Methods

With a standardized focus group guide, we assessed cigar use behaviors and perceptions among lifetime cigar users (N = 47; 8 focus groups separated by sex and age group [adolescents, young adults]) in 2016. We analyzed data related to blunts.

Results

Overall, 85.5% of the participants had smoked a blunt in the past 30 days (38% used daily). Participants perceived that cheap cigar brands were used primarily for blunts. Cigar product features that made them useful for blunts included wide availability, easy accessibility (easy to bypass underage purchasing restrictions), attractive flavors, inexpensive cost, perforated wrappers that make cigars easy to open, and ability to remove the inner wrapper (also referred to as "cancer paper") to reduce the risk of harm.

Conclusions

Various product features of cigars make it easy for adolescents and young adults to manipulate them to create blunts. Tobacco regulations that include restrictions on product characteristics, as well as enforcement of prohibition of sales of cigars to underage minors are needed. Youth also need to be educated about harms of blunt use.

Characterizing Blunt Smokers by Their Acquisition of Cannabis

BACKGROUND

Ethnographers have reported that young, urban males embraced blunt smoking in response to the crack cocaine epidemic that ravaged their neighborhoods in the 1980s. But, recent survey data has indicated high rates of other illicit drug use among blunt smokers.

OBJECTIVES

The objective of this study was to examine the association between blunt smoking and cannabis acquisition as a potential explanation for the correlation with other illicit drug use.

METHODS

The sample consisted of participants from the 2014 National Survey on Drug Use and Health (NSDUH) who reported use of cannabis or blunts in the prior month (n = 6,040). Logistic regression was used in estimating measures of demographics, access to illicit drugs, access to medical cannabis, frequency of cannabis/blunt use, and type of blunt smoker as correlates of a cannabis purchase versus other means of acquisition (e.g. sharing it).

RESULTS

Accounting for other variables, current blunt smokers had 1.4 times the odds of purchasing cannabis relative to the cannabis users who had never smoked a blunt. Furthermore, the current blunt smokers had greater odds of purchasing cannabis frequently and making the purchases in outdoor settings. Conclusions/Importance: The findings suggest that current blunt smokers compared to other cannabis users are at greater risk of the dangers associated with illegal drug transactions. The legalization of recreational cannabis in some U.S. states is coinciding with the growth of a cannabis black market, highlighting the need for the continued assessment of cannabis acquisition in NSDUH questionnaires.

Characterizing Blunt Use Among Twitter Users: Racial/Ethnic Differences in Use Patterns and Characteristics

BACKGROUND

Young adult Twitter users are exposed to and often participate in tweets that promote risky behaviors, such as blunt use. Blunts are hollowed out cigars or cigarillos that are filled with marijuana.

OBJECTIVES

The current study was designed to determine the use patterns and characteristics of African American, Hispanic and White young adult Twitter users who reported past month blunt use.

METHODS

Young adults (N = 753, 74% male) who reported past month blunt use were recruited via Twitter to participate in a brief anonymous online survey about their blunt use.

RESULTS

Findings revealed that African American young adults initiated blunt smoking at an earlier age (14.8 years), reported more days of blunt smoking in the past month (23.2 days) and smoked more blunts in the past month (27.2 blunts) than their Hispanic (16.5 years, 19.7 days, and 15.4 blunts) and White (18.1 years, 15.8 days, and 22.2 blunts) counterparts, p <.01. African American young adults were more likely than their White counterparts to report physical craving as an obstacle to quitting blunt smoking. Several racial/ethnic differences were also found on attitudes about blunt use and reasons for initiating and continuing to smoke blunts.

CONCLUSIONS

Findings suggest that blunt use patterns and attitudes about blunt use vary by race/ethnicity. Understanding racial/ethnic differences in blunt use patterns and characteristics offers opportunities to tailor future interventions and enhance outcomes among African American, Hispanic and White young adults.

Humanizing folk devils using ethnography

The sociological concepts of the "moral panic" and the deviant "folk devil" apply to the drug panics in the United States over methamphetamine, heroin, and crack cocaine. Mothers or pregnant women who smoke crack cocaine, and their babies, are assigned exaggerated "demonic" attributes that result in stigma and societal rejection. Otherwise, ethnographic studies of drug users demonstrate realities that are other than what might be considered were one to merely look at their use and the consequences. These considerations are examined with respect to the image of folk devils, methadone program attendees, smokers of "blunts," opium den habitués, and others grouped together as negative influences as a result of their drug habits.

Perspectives on Daily Cannabis use: Consumerism or a Problem for Treatment?

AIM – To discuss similarities and differences in the way cannabis users with and without treatment experiences present their trajectories into daily use of cannabis. To observe the differences in patterns between the cannabis users' descriptions of their recreational use and the development from a recreational to a more problematic use of cannabis. METHODS – Qualitative interviews were conducted with 32 adult cannabis users in Denmark. All respondents used cannabis daily. The respondents were 22–61 years old; 16 had had experiences with cannabis treatment while 16 had not. By using a mixed sample of respondents with and without treatment experiences, we were able to compare perspectives on cannabis initiation and trajectories not commonly examined. FINDINGS – All the respondents had started to use cannabis socially as adolescents in the company of peers, using it with specific peer groups and in particular social contexts. All the respondents viewed it as a positive practice. The respondents highlighted certain differences of why, how and when cannabis was used as crucial in explaining how cannabis use had remained a recreational activity or had become problematic. Four trajectories into daily cannabis use were constructed from the users' narratives. For some respondents, daily cannabis use in adulthood was an inclusive and non-problematic activity while others described their cannabis use developing into a problematic and exclusive habit. CONCLUSIONS – Trajectories into and continuation of daily use is understood and perceived in different ways by daily cannabis users. It is not the amount of cannabis that determines whether daily use is considered problematic nor not. Rather, it is how, when and with whom cannabis is used that forms experiences and perceptions of problematic or unproblematic use.

Marijuana and tobacco co-administration in blunts, spliffs, and mulled cigarettes: A systematic literature review

BACKGROUND

Blunts and spliffs/mulled cigarettes combine marijuana and tobacco for co-administration (use at the same time, in the same product). Co-administration of marijuana and tobacco presents significant potential for nicotine exposure, and may lead to exclusive tobacco use patterns, nicotine addiction, and compounded health effects. No review articles have summarized the number and nature of studies published on these co-administered products.

METHODS

Keywords "(blunt* OR spliff OR mull* OR joint) AND (tobacco OR smok* OR cigarette) AND (cannabis OR marijuana OR hashish)" were searched in the published literature. A total of 220 articles were considered for inclusion, 49 were reviewed by two independent qualitative coders, and 45 were included in this review.

RESULTS

Of the 45 articles, most (n=27) of studies were observational or descriptive; ten were qualitative, five employed causal designs, and three were mixed methods. A majority of the studies assessed blunts; only 11 studies assessed spliffs/mulled cigarettes. Many studies focused on sub-populations of youth, males, and African Americans. Use of co-administered marijuana and tobacco products was associated with several indicators of problematic use patterns, including perceptions of less risk, dependence on nicotine and marijuana, and greater subjective effects related to marijuana.

CONCLUSIONS

Literature on marijuana and tobacco co-administration comes largely from qualitative and observational/descriptive studies. In addition to continued surveillance, experimental research that directly assesses the smoking patterns of co-administered marijuana and tobacco products as compared with to those of marijuana and tobacco only products is needed to determine the potential long-term health consequences of using blunts, spliffs, or other co-administered products.

Patterns of the co-use of alcohol, marijuana, and emerging tobacco products in a national sample of young adults

BACKGROUND

Emerging tobacco product use is on the rise in young adults and has been linked to alcohol and marijuana use. Little is known about which patterns of alcohol, marijuana, and emerging tobacco product co-use are most popular in this age group.

OBJECTIVES

This study examined the prevalence of a broad spectrum of marijuana, alcohol, and tobacco co-use patterns across a variety of tobacco products in a national sample of young adults.

METHODS

Data were analyzed from a sub-set of 18-24 year olds (unweighted n = 3,940) from five waves of the Truth Initiative Young Adult Cohort, a national sample of 18-34 year olds. A user-generated statistical program in R was used to assess all possible patterns of past 30-day use of alcohol, marijuana, cigarettes, cigars, e-cigarettes, little cigars/cigarillos, hookah, and other tobacco (pipe, chew, dip, snus, dissolvables).

RESULTS

No past 30-day use of any substance emerged as the most popular pattern across all years (42%), followed by exclusive past 30-day alcohol use (31%), and past 30-day alcohol use with cigarettes (5%) or marijuana (4%). The popularity of exclusive marijuana use increased over time, but only 1% reported exclusive marijuana use without the combination of either alcohol or a tobacco product. E-cigarette use only emerged in combination with alcohol and was the least popular pattern of co-use relative to other patterns.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Patterns stress the importance of alcohol among young people. Successful substance use prevention should focus on alcohol's co-use with a variety of substances of abuse, rather than focus on a single behavior. (Am J Addict 2016;25:634-640).

Pills, Thrills and Bellyaches: Case Studies of Prescription Pill Use and Misuse among Marijuana/Blunt Smoking Middle Class Young Women

Recent survey research has documented important increases during the 2000s in the misuse and abuse of several prescription drugs (Vicodin, Percocet, Codeine, Dilaudid, Xanax, Klonopin, Valium, Ativan, Adderall, Ritalin, among others). This article focuses upon the patterns of pill use and misuse among young women who are middle-class white and college-educated, and they are also experienced marijuana users who report recreational consumption of other illegal drugs. The ethnographic data provides insights about various ways and reasons that such prescription pill misuse occurs among 12 college-educated, (upper) middle-class, white/Asian women in their 20s who were involved in a major ethnographic study of marijuana and blunts. Three patterns of pill use were observed: recreational; quasi-medical; and legal medical; shifts among these patterns of pill use was common. Few reported that their pill use interfered with their conventional jobs and lifestyles; they concealed such use from their employers and coworkers, and from non-using friends and family members. None reported contacts with police nor seeking treatment specifically for their pill misuse. Many reported misusing prescription pills in conjunction with illegal drugs (marijuana, cocaine, ecstasy) and alcohol. Pills were used as a way to enhance the euphoric effects of other drugs, as well as a way to avoid the negative side effects of illegal drugs. Some reported pill use as a means for reducing expenditures (and use of) alcohol and cocaine. The implications suggest a hidden subpopulation of prescription pill misusers among regular users of marijuana and other illegal drugs. Future research should include users and misusers of various pills to better understand how prescriptions pills interact with illegal drug use patterns.

Modes of ever marijuana use among adult tobacco users and non-tobacco users-Styles 2014

BACKGROUND

Tobacco and marijuana use are related behaviors; therefore, it is important to identify how users consume marijuana, and how it varies with tobacco use status. We estimated the modes of ever marijuana use among current, former, and never adult tobacco users.

METHODS

Weighted data were analyzed for 4181 adults from 2014 Styles, an online consumer panel survey of US adults, to estimate proportions for modes of ever marijuana use. Differences in modes of ever marijuana use between categories of tobacco use status were assessed (p-value <0.05).

RESULTS

More than half of current (56.6%) and former tobacco users (50.9%) had ever used marijuana, whereas only 13.0% of never tobacco users had ever used marijuana. Among ever marijuana users, joint use was the most common mode of use among current (86.4%), former (92.5%), and never (79.8%) tobacco users. Similarly, other modes of marijuana use were significantly higher in current and former tobacco users compared to never tobacco users.

CONCLUSIONS

Prevalence of all modes of ever marijuana use was higher in current and former tobacco users. These findings underscore the importance of considering the relationship between marijuana and tobacco use when developing programs and policies aimed at preventing and reducing marijuana use.

Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health

BACKGROUND

Smoking marijuana in a cigar (blunt use) is gaining popularity in the U.S. Research suggests that blunt users differ from exclusive cigar or marijuana users on a variety of demographic and substance use factors. Misreporting of blunts and cigars is also common, particularly among young people, and may lead to inaccurate prevalence estimates. To determine subtype differences, this study investigated the prevalence and demographic, mental health, and substance use correlates of four mutually-exclusive groups of blunt, cigar, and marijuana past 30-day users (cigar-only, blunt-only, non-blunt marijuana, or dual cigar-blunt).

METHOD

Data were analyzed from the 2013 National Survey of Drug Use and Health.

RESULTS

In weighted multinomial logistic regression models, respondents who were younger, Black, and who had used tobacco, alcohol, or other drugs in the past 30-days had the highest odds of reporting blunt-only or dual cigar-blunt use. Those reporting blunt-only and dual cigar-blunt use also endorsed a greater number of marijuana and alcohol use disorder symptoms compared to those reporting cigar-only and non-blunt marijuana use. Lower marijuana risk perceptions were associated with increased odds of marijuana use with or without blunts. Major depressive episode was uniquely associated with non-blunt marijuana use. With respect to misclassifiers, respondents who reported past 30-day blunt use but not past 30-day marijuana use were younger, Black, female, and had lower education and income.

DISCUSSION

Those who report blunt-only and dual cigar-blunt use showed the most severe risk profiles. Communicating health consequences and risks of blunt use should be directed toward specific subgroups.

"I just use it for weed": The modification of little cigars and cigarillos by young adult African American male users

Little cigar and cigarillo (LCC) use has received increased attention, but research on their modification is limited. Qualitative interviews with 17 young adult African American male LCC users investigated tobacco use behaviors and patterns, including LCC modification. The modification of LCCs for use as blunts emerged as a very prominent aspect of LCC users' tobacco use. Four subthemes regarding marijuana and blunt use are explored in this article, including participants' explanations of how blunts are made and used, concurrent use of marijuana and tobacco, perceptions and reasons for smoking marijuana and blunts, and perceptions of the risks of blunt use.

Symbolic boundaries, subcultural capital and prescription drug misuse across youth cultures

Prescription drug misuse among young adults has surged over the past decade. Yet the contexts surrounding this misuse remain unclear, particularly the subcultural contexts. Many young urban adults participate in youth cultures. This article describes the subcultural contexts of prescription drug misuse in youth subcultures. Drawing on ethnographic data collected over 12 months from different youth cultural scenes, the authors describe the subcultural bases of prescription drug misuse. The symbolic boundaries and subcultural capital inherent in these scenes shape the ways youth think about drugs and behave accordingly. While young adults are often lumped together by theorists, ethnographic data show considerable variation across these subcultures with regard to what may enable or inhibit prescription drug misuse. The broader subcultural ethos in each scene, as well as attitudes towards other types of drugs, frame the ways that prescription drugs are perceived and used in each of these settings. The findings highlight the role of symbolic boundaries and subcultural capital in shaping routine practices of drug use among young adults. These data show that education campaigns about prescription drug misuse should take into account the variability in youth cultural scenes to maximise the efficacy of these messages aimed at young adults.

Taste clusters of music and drugs: evidence from three analytic levels

This article examines taste clusters of musical preferences and substance use among adolescents and young adults. Three analytic levels are considered: fixed effects analyses of aggregate listening patterns and substance use in US radio markets, logistic regressions of individual genre preferences and drug use from a nationally representative survey of US youth, and arrest and seizure data from a large American concert venue. A consistent picture emerges from all three levels: rock music is positively associated with substance use, with some substance-specific variability across rock sub-genres. Hip hop music is also associated with higher use, while pop and religious music are associated with lower use. These results are robust to fixed effects models that account for changes over time in radio markets, a comprehensive battery of controls in the individual-level survey, and concert data establishing the co-occurrence of substance use and music listening in the same place and time. The results affirm a rich tradition of qualitative and experimental studies, demonstrating how symbolic boundaries are simultaneously drawn around music and drugs.

Availability of tobacco products associated with use of marijuana cigars (blunts)

OBJECTIVES

This study examines factors associated with availability of tobacco products for marijuana cigars (i.e., blunts) in 50 non-contiguous mid-sized California communities.

METHODS

The study is based on data collected in 943 tobacco outlets. Neighborhood demographics, community adult marijuana prevalence, medical marijuana policy and access to medical marijuana dispensaries and delivery services were included.

RESULTS

Multilevel logistic regression analyses indicated that compared with small markets, availability of tobacco products associated with use of blunts was significantly higher in convenience stores, smoke/tobacco shops and liquor stores. None of the neighborhood demographics were associated with availability of blunt wrappers and only a small percent of Whites was positively associated with availability of blunt cigars, small cigars or cigarillos at the store. Controlling for outlet type and neighborhood demographics, higher city prevalence of adult marijuana use was associated with greater availability of blunt wrappers. Also, policy that permits medical marijuana dispensaries or private cultivation was positively associated with availability of tobacco products for blunts. Density of medical marijuana dispensaries and delivery services, however, was negatively associated with greater availability of these products at tobacco outlets.

CONCLUSIONS

Results suggest that availability of tobacco products associated with blunts is similar in neighborhoods with different socioeconomic status and racial and ethnic composition. Results also suggest the important role that community norms that support marijuana use or legalization of medical marijuana and medical marijuana policy may play in increasing availability of tobacco products associated with blunts.

"Counselor in Your Pocket": Youth and Provider Perspectives on a Mobile Motivational Intervention for Marijuana Use

Previous interventions for marijuana use have been administered out of the real-life contexts in which use occurs. In 2010, we interviewed youth aged 15-24 years who use marijuana frequently (n = 8) and providers who treat them (n = 6) on the acceptability and utility of a mobile intervention involving momentary self-monitoring of use-related contexts and responsive motivational messaging following clinic-based brief motivational enhancement therapy. Thematic analysis was used to examine youth and provider perspectives on the mobile intervention. Results suggest that mobile technology is a promising tool for brief interventions to reduce youth marijuana use and warrants further development.

The changing demographic of blunt smokers across birth cohorts

BACKGROUND

It has been suggested that African-American males, born in the 1970s, initiated the practice of smoking blunts during the rise of the hip-hop subculture in the 1990s. The objective of this study was to determine if other racial/ethnic groups from more recent birth cohorts adopted the practice as well.

METHODS

Data from seven cross-sectional surveys, the 2004-2010 National Surveys on Drug Use and Health, were aggregated for constructing six five-year birth cohorts (n=297,478), starting with the 1970-1974 cohort. Age-stratified regression models were then developed to test the effect of the interaction between race/ethnicity and birth cohort on the past-year use of blunts.

RESULTS

Fewer differences in the prevalence of past-year blunt smoking were observed between African-Americans and other racial/ethnic groups from more recent birth cohorts. Statistically significant interaction terms in age-stratified models indicated that relative to African-Americans, the odds ratios of blunt smoking were greater in Caucasians and Hispanics born in the1980s compared to those born in the late 1970s. These results were replicated when the sample was limited to past-year cannabis users (n=61,038).

CONCLUSIONS

African-Americans, who likely initiated blunt smoking as adolescents/young adults in the 1990s, continued the practice into adulthood. As characterized by other drug eras, the drug became popular over time and expanded into other demographic groups. The additional exposure to tobacco should alert tobacco-control advocates about blunt smokers' risk of developing nicotine dependence.

“A Friend With Weed Is a Friend Indeed”

The importance of friendship networks and drug sharing is a well-documented feature of marijuana use. Recent studies show an increased role of acquiring marijuana through friends, especially in settings with rather punitive drug policy. This article aims at gaining insight into the definitions and roles that marijuana users attribute to friendship. Forty-four marijuana users and retailers recruited in North Central Florida were subjected to semistructured interviews, with extensive probes on respondents’ “friends.” Data were analyzed with the use of inductive analysis, and were framed in identity theory. Respondents’ definitions of friendship contained expectations on marijuana sharing and reciprocation, purchases for friends, and introduction to dealers—who were also referred as “friends.” The study findings suggest that marijuana users’ definitions of friendship include expectations for behavior that sustain the distribution chain. Role-based expectations on “friendly” behavior served as a social control tool that protected marijuana users from illicit market risks.

Individual and contextual predictors of severity of marijuana use events among young frequent users

This study used momentary sampling to characterize marijuana events among young frequent users and determine contextual and individual predictors of use severity. Medical clinic outpatients aged 15-24 who used marijuana at least twice a week completed a baseline assessment, then used a handheld computer to report marijuana use at 4-6 signal-prompted times per day and before/after use for 2 weeks. Reports assessed event characteristics (when, with whom, where, how, why, how much, how high). Timestamps identified time, weekend, and duration for each event. Generalized estimating equations tested associations of individual and event-specific contextual characteristics with hits/event, duration, and high. Forty-one youth completed 3868 momentary reports; 40 (98%) reported at least one marijuana use event (N=432 events; M=10.5/participant) and thus provided data for these analyses. Marijuana was most commonly used with other people (74% of events), at home (58%), via blunt (66%), and for social or enhancement reasons (86%). Most events (62%) occurred on weekdays; use was least likely in the morning (8%). Most events involved 6 or more hits (81%). Mean high was 5.2 (out of 8). Of events with start and end times (n=250), mean duration was 46.8 min. Poor mental health and use with a blunt or a bong, in the morning or evening, and on the weekend were associated with 6 or more hits/event. Female gender was associated with greater event duration. Poor mental health predicted higher high. Among youth who used it frequently, marijuana was used in a variety of contexts, with diversity in method, dose, and duration. Contextual factors appeared to predict marijuana dose for a given event, while individual characteristics were more predictive of high and duration.

Prescription drug misuse among young adults: looking across youth cultures

INTRODUCTION AND AIMS

Youth cultures play a key role in the social organisation of drug trends among young people; the current prescription drug misuse trend is no different. The authors evaluated whether patterns of prescription drug misuse differed across several youth cultures.

DESIGN AND METHODS

Using field survey methods and time-space sampling during 2011, the authors assessed the patterns and prevalence of prescription drug misuse among young adults who are socially active in various urban youth cultures (n = 1781).

RESULTS

The prevalence of lifetime prescription drug misuse is highest within indie rock scenes (52.5%), electronic dance music scenes (52.1%), lesbian parties (53.8%) and alt scenes (50.9%). Prescription drug misuse was lowest among young adults in hip-hop scenes (25.0%). These findings were upheld in logistic regression analyses that accounted for demographic differences across youth cultures: indie rock scenes (adjusted odds ratio = 2.11), electronic dance music scenes (adjusted odds ratio = 2.20), lesbian parties (adjusted odds ratio = 2.30) and alt scenes (adjusted odds ratio = 2.65) all reported statistically significant (P < 0.05) higher odds of misuse than college bar scenes. Recent prescription drug misuse mirrored patterns for lifetime misuse.

DISCUSSION AND CONCLUSIONS

The differing prevalence of prescription drug misuse across distinct youth cultures suggests that the trend has not diffused equally among young people. The differing prevalence across youth cultures indicates that the most efficacious strategies for youth intervention may be targeted approaches that account for the subculturally rooted differences in attitudes and social norms.

Correlates of concurrent energy drink and alcohol use among socially active adults

BACKGROUND

Research indicates that energy drink consumption and the combined use of energy drinks and alcohol are popular among young adults, although this research has typically focused on college students. Because of the potential for harms associated with this combination, it is critical to understand use among adults in nightlife scenes who may be most at risk for harms associated with combined energy drink and alcohol consumption.

OBJECTIVES

By focusing our sample on individuals in a range of nightlife scenes, we aim to gain a deeper understanding of the demographic factors associated with energy drink use and combined energy drink and alcohol consumption to benefit the targeting of intervention and prevention efforts beyond college campuses.

METHODS

Using a field-based survey in New York City to survey adults active in various nightlife scenes, this study reports on the survey results of 1476 venue patrons at venues in five nightlife scenes in addition to college bar scenes.

RESULTS

Men, younger individuals, Latinos, and sexual minority individuals reported higher prevalence of recent energy drink consumption. Younger individuals, men, and those recruited in gay venues reported higher prevalence of combining alcohol and energy drinks.

CONCLUSION

These findings provide information useful to target education and prevention efforts. They also suggest the need for additional research to understand differences in motivations for use and in the behavioral and alcohol-related outcomes associated with consuming energy drinks and combining them with alcohol.

Patterns of and motivations for concurrent use of video games and substances

“Behavioral addictions” share biological mechanisms with substance dependence, and “drug interactions” have been observed between certain substances and self-reinforcing behaviors. This study examines correlates of patterns of and motivations for playing video games while using or feeling the effects of a substance (concurrent use). Data were drawn from a nationally-representative survey of adult Americans who “regularly” or “occasionally” played video games and had played for at least one hour in the past seven days (n = 3,380). Only recent concurrent users’ data were included in analyses (n = 1,196). Independent variables included demographics, substance use frequency and problems, game genre of concurrent use (identified by looking titles up in an industry database), and general game playing variables including problem video game play (PVP), consumer involvement, enjoyment, duration, and frequency of play. Exploratory factor analysis identified the following dimensions underlying patterns of and motivations for concurrent use: pass time or regulate negative emotion, enhance an already enjoyable or positive experience, and use of video games and substances to remediate each other’s undesirable effects. Multivariate regression analyses indicated PVP and hours/day of video game play were associated with most patterns/motivations, as were caffeine, tobacco, alcohol, marijuana, and painkiller use problems. This suggests that concurrent use with some regular situational pattern or effect-seeking motivation is part of the addictive process underlying both PVP and substance dependence. Various demographic, game playing, game genre of concurrent use, and substance use variables were associated with specific motivations/patterns, indicating that all are important in understanding concurrent use.

'Smoking': use of cigarettes, cigars and blunts among Southeast Asian American youth and young adults

Increased use of cigars has been noted among youth, as well as use of blunts (hollowed-out cigars filled with marijuana). Three types of relationships have been previously hypothesized between use of tobacco and marijuana in substance use progression. We aimed to assess these relationships for Southeast Asian American youth and adults in an urban population. We conducted in-person interviews with 164 Southeast Asians, smokers and non-smokers, in two low-income urban communities in Northern California, collecting both quantitative and qualitative data. Analysis of the quantitative data indicated distinct use patterns for blunts, cigars and other forms of marijuana in terms of associations with generation in the United States. The use of these items was also found to be related: ever having smoked cigarettes or blunts increased the risk of ever having smoked the other three items. Qualitative data found indications of all three hypothesized relationships between tobacco and marijuana for youths but not for older adults. For youths in the study, 'smoking' was found to constitute a social construct within which use of cigarettes, cigars and blunts were somewhat interchangeable. Youths in similar settings may initiate into and progress through smoking as an activity domain rather than any one of these items.

Bogarting that joint might decrease oral HPV among cannabis users

Human papilloma virus (HPV) has many known strains, two of the most well studied perhaps being the high-risk types 16 and 18. These strains have attracted more interest because they are known to disrupt tumour-suppressor genes that control the cell cycle, rendering those genes less effective at keeping cell division in check.Within the last decade, an increase in oral hpv-linked cancers of the throat and tongue has been attributed to exposure and contraction of hpv through oral sex, most notably in younger people. An understudied and arguably equal contributor to oral hpv infection might be indirect contact with an infected person. Presented here is a brief but important perspective on the relationship between cannabis use and oral cancer. The development of oral cancer is not a result of smoking cannabis per se; rather, it is hypothesized to be a result of contracting hpv through various forms of sharing and passing joints and other smoking apparatuses. Therefore, it is hypothesized that bogarting (and not passing) joints might decrease oral hpv among cannabis smokers. Future research should therefore investigate the prevalence of oral hpv in cannabis smokers to better understand its epidemiology.

A comparison of drug use and dependence between blunt smokers and other cannabis users

Ethnographic studies have suggested that blunt smokers represent a subculture of cannabis users whose drug use is moderated by social norms. The objective of this study was to compare rates of cannabis dependence/abuse and nicotine dependence between blunt and other cannabis smokers. The sample included adolescents and young adults (n = 4348) who reported some form of past-month cannabis use in the 2004 National Survey on Drug Use and Health. Compared to smokers who never used blunts, blunt smokers had significantly greater odds of being dependent on cannabis and tobacco. Associations with cannabis dependence/abuse remained statistically significant with adjustment for smoking frequency and demographic characteristics. These findings highlight the need for differentiating types of cannabis users in epidemiologic studies. The study's limitations are noted.

Smoking tobacco along with marijuana increases symptoms of cannabis dependence

AIM

User practices/rituals that involve concurrent use of tobacco and marijuana - smoking blunts and "chasing" marijuana with tobacco - are hypothesized to increase cannabis dependence symptoms.

DESIGN

Ethnographers administered group surveys to a diverse, purposive sample of marijuana users who appeared to be 17-35 years old.

SETTING

New York City, including non-impoverished areas of Manhattan, the transitional area of East Village/Lower East Side, low-income areas of northern Manhattan and South Bronx, and diverse areas of Brooklyn and Queens.

PARTICIPANTS

481 marijuana users ages 14-35, 57% male, 43% female; 27% White, 30% Black, 19% Latino, 5% Asian, 20% of other/multiple race.

MEASUREMENTS

Among many other topics, group surveys measured cannabis dependence symptoms; frequencies of chasing, blunt smoking, joint/pipe smoking, using marijuana while alone, and general tobacco use; and demographic factors.

FINDINGS

Blunt smoking and chasing marijuana with tobacco were each uniquely associated with five of the seven cannabis dependence symptoms. Across symptoms, predicted odds were 2.4-4.1 times greater for participants who smoked blunts on all 30 of the past 30 days than for participants who did not smoke blunts in the past 30 days. Significant increases in odds over the whole range of the five-point chasing frequency measure (from never to always) ranged from 3.4 times to 5.1 times.

CONCLUSIONS

Using tobacco with marijuana - smoking blunts and "chasing" marijuana with tobacco - contributes to cannabis dependence symptoms. Treatment for cannabis dependence may be more effective it addresses the issue of concurrent tobacco use.

Civic norms and etiquettes regarding marijuana use in public settings in New York City

This paper shows that active police enforcement of civic norms against marijuana smoking in public settings has influenced the locations where marijuana is smoked. It has subtly influenced the various marijuana etiquettes observed in both public and private settings. The ethnographic data reveal the importance of informal sanctions; most marijuana consumers report compliance with etiquettes mainly to avoid stigma from nonusing family, friends, and associates-they express limited concern about police and arrest.

An Analysis of Alternatives to New York City's Current Marijuana Arrest and Detention Policy

During the 1990s, the New York Police Department (NYPD) instituted a policy of arresting and detaining people for minor offenses that occur in public as part of their quality-of-life (hereafter QOL) policing initiative. The number of NYPD arrests for smoking marijuana in public view (MPV) increased from 3,000 in 1994 to over 50,000 in 2000, and have been about 30,000 in the mid 2000s. Most of these arrestees (84%) have been minority; blacks have been 2.7 more likely and Hispanics 1.8 times more likely to be detained than whites for an MPV arrest. Minorities have been most likely to receive more severe dispositions, even controlling for demographics and prior arrest histories.This paper examines the pros and cons of the current policy; this is compared with possible alternatives including the following: arrest and issue a desk appearance ticket (DAT); issue a non-criminal citation (violation); street warnings; and tolerate public marijuana smoking. The authors recommend that the NYPD change to issuing DATs on a routine basis. Drug policy reformers might wish to further pursue changing statutes regarding smoking marijuana in public view into a violation (noncriminal) or encourage the wider use of street warnings. Any of these policy changes would help reduce the disproportionate burden on minorities associated with the current arrest and detention policy. These policies could help maintain civic norms against smoking marijuana in public.

The potential for accurately measuring behavioral and economic dimensions of consumption, prices, and markets for illegal drugs

There are numerous analytic and methodological limitations to current measures of drug market activity. This paper explores the structure of markets and individual user behavior to provide an integrated understanding of behavioral and economic (and market) aspects of illegal drug use with an aim toward developing improved procedures for measurement. This involves understanding the social processes that structure illegal distribution networks and drug users' interactions with them. These networks are where and how social behaviors, prices, and markets for illegal drugs intersect. Our focus is upon getting an up close measurement of these activities. Building better measures of consumption behaviors necessitates building better rapport with subjects than typically achieved with one-time surveys in order to overcome withholding and underreporting and to get a comprehensive understanding of the processes involved. This can be achieved through repeated interviews and observations of behaviors. This paper also describes analytic advances that could be adopted to direct this inquiry including behavioral templates, and insights into the economic valuation of labor inputs and cash expenditures for various illegal drugs. Additionally, the paper makes recommendations to funding organizations for developing the mechanisms that would support behavioral scientists to weigh specimens and to collect small samples for laboratory analysis-by providing protection from the potential for arrest. The primary focus is upon U.S. markets. The implications for other countries are discussed.

Retail marijuana purchases in designer and commercial markets in New York City: sales units, weights, and prices per gram

This paper documents the bifurcation of the market for commercial marijuana from the market for designer marijuana in New York City. Commercial marijuana is usually grown outdoors, imported to NYC, and of average quality. By contrast, several varities of designer marijuana are usually grown indoors from specially bred strains and carefully handled for maximum quality. The mechanisms for marijuana sales include street/park sellers, delivery services, private sales, and storefronts. Retail sales units vary from 5 dollars to 50 dollars and more, but the actual weights and price per gram of retail marijuana purchases lacks scientific precision. Ethnographic staff recruited marijuana purchasers who used digital scales to weigh a purposive sample of 99 marijuana purchases. Results indicate clear differences in price per gram between the purchases of commercial (average 8.20 dollars/g) and designer (average 18.02 dollars/g) marijuana. Designer purchases are more likely to be made by whites, downtown (Lower East Side/Union Square area), via delivery services, and in units of 10 dollar bags, 50 dollar cubes, and eighth and quarter ounces. Commercial marijuana purchases are more likely to be made by blacks, uptown (Harlem), via street dealers, and in units of 5 dollar and 20 dollar bags. Imported commercial types Arizona and Chocolate were only found uptown, while designer brand names describing actual strains like Sour Diesel and White Widow were only found downtown. Findings indicate clear divisions between commercial and designer marijuana markets in New York City. The extent that these differences may be based upon different THC potencies is a matter for future research.

Social constructions of dependency by blunts smokers: Qualitative reports

Concerns about the risk of cannabis dependence have been renewed in recent years by changing patterns of consumption, including increased levels of use, easier access to high-potency strains of cannabis and the rising popularity of blunts (tobacco cigar shells filled with cannabis). Such concerns have been reinforced by a number of studies suggesting that cannabis dependence, as measured by DSM criteria, has indeed increased. However, there are reasons to question these findings. First, the studies may not accurately reflect users' experiences, for a number of methodological and conceptual reasons. Equally important, they do not examine the practice of smoking blunts, which exposes cannabis users to nicotine and has obvious implications for dependence (and other health problems). In this paper we reveal social understandings of dependence by analysing in-depth interviews with 92 users of blunts and cannabis in other forms in New York City. We also discuss ethnographic observations of these users and others that reveal practises and norms relevant to the risk of cannabis dependence. We find that users' experiences and descriptions do not correspond to official dependence criteria and that some use practices, such as smoking blunts in groups, promote moderate consumption rather than compulsive use. Respondents also associated nicotine with dependence, suggesting that research on cannabis dependence should be designed to include blunt smoking.