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Kreslake JM, Mills S, Liu M, Diaz MC, Kostygina G, Emery S, Hair EC. Youth and Young Adult Blunt Use Predicts Progression to Other Nicotine Product Use in the United States. Subst Use Misuse 2023; 59:263-268. [PMID: 37881835 PMCID: PMC10766086 DOI: 10.1080/10826084.2023.2269561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Little cigars or cigarillos (LCCs) are frequently modified to smoke cannabis ("blunts") by youth and young adults. This study investigated whether young blunt users who are otherwise nicotine-naïve are more likely to initiate other tobacco products compared to never blunt users. METHODS AND MATERIALS Data were from four waves of the Truth Longitudinal Cohort (TLC), a national probability-based sample of youth and young adults (aged 15-24 years) in the United States (Wave 1: January-April 2017; Wave 2: February-May 2018; Wave 3: February-May 2019; Wave 4: September-December 2019). The sample was restricted to nicotine naïve respondents at Wave 1 with possible ever use of blunts (N = 5,284). Logistic regression analyses tested whether ever blunt use at Wave 1 predicted initiation of nicotine products by Wave 4, controlling for established risk factors. RESULTS Compared to never-blunt users, ever users of blunts at Wave 1 had significantly higher odds of ever using cigars (OR: 4.74; 95% CI: 1.80-12.47; p = 0.002), e-cigarettes (OR: 4.66; 95% CI: 2.42-8.95; p < 0.001), cigarettes (OR: 3.02; 95% CI: 1.17-7.84, p = 0.023), or hookah (OR: 3.47; 95% CI: 1.07-11.29, p = 0.039) by Wave 4. Cannabis (never blunt) use by Wave 1 predicted ever use of e-cigarettes (OR: 3.45, 95% CI: 2.38-5.02, p < 0.001), cigarettes (OR: 3.81; 95% CI: 2.26-6.43, p < 0.001), or hookah (OR: 2.13; 95% CI: 1.12-4.05, p = 0.021) by Wave 4. DISCUSSION Blunts are a point of nicotine initiation that places users at increased risk of progression to cigars, while the same relationship was not found for cannabis alone.
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Affiliation(s)
| | - Sarah Mills
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Michael Liu
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Sherry Emery
- NORC at the University of Chicago, Chicago, Illinois, USA
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Morean ME, Kong G, Bold KW, Davis DR, Krishnan-Sarin S. Accurately classifying cannabis blunt use as tobacco-cannabis co-use versus exclusive cannabis use. Drug Alcohol Depend 2023; 249:109941. [PMID: 37270936 PMCID: PMC10330737 DOI: 10.1016/j.drugalcdep.2023.109941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Historically, blunt use constituted tobacco-cannabis co-use based on the products available for creating blunts (e.g., hollowed-out cigars filled with cannabis). With the introduction of tobacco-free blunt wraps (e.g., hemp wraps), blunt use now may constitute tobacco-cannabis co-use or exclusive cannabis use. We examined adolescents' use of tobacco and tobacco-free blunt products and highlighted how misclassification of tobacco-cannabis co-use versus exclusive cannabis use may occur if products used to make blunts are not assessed. METHODS 4855 students from eight Connecticut high schools completed an online survey in 2022. Use of tobacco products for making blunts (e.g., cigarillos, tobacco blunt wraps) and tobacco-free blunt wraps were assessed as was the use of other tobacco products (e.g., e-cigarettes, cigarettes, hookah). The analytic sample comprised 475 students who endorsed lifetime blunt use. RESULTS Tobacco-free blunt wraps (72.6%) were the most popular product for making blunts, followed by cigarillos (56.5%), tobacco blunt wraps (49.2%), and large cigars (13.0%). When classified into mutually exclusive groups, students reported exclusive tobacco-free blunt use (32.3%), exclusive tobacco product blunt use (27.4%), or use of both tobacco product and tobacco-free blunts (40.3%). Among those exclusively using tobacco-free blunts, 13.4% endorsed no tobacco product use. CONCLUSIONS Tobacco-free blunt wraps were very popular among high school adolescents, highlighting the importance of assessing products used for making blunts. Assuming that blunts contain tobacco without considering tobacco-free blunts can lead to misclassification of blunt use as tobacco-cannabis co-use when it actually reflects exclusive cannabis use, potentially leading to inflated estimates of tobacco use. DATA AVAILABILITY Data will be made available upon reasonable request to the corresponding author.
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Affiliation(s)
- Meghan E Morean
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New HavenCT06519USA.
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New HavenCT06519USA
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New HavenCT06519USA
| | - Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New HavenCT06519USA
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Fairman BJ, Kimmel HL, Blanco C, Compton WM. Blunt and non-blunt cannabis use associated with cigarette, e-cigarette, and cigar initiation: Findings from the population assessment of tobacco and health (PATH) study. Drug Alcohol Depend 2023; 246:109837. [PMID: 36931132 PMCID: PMC10161973 DOI: 10.1016/j.drugalcdep.2023.109837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/14/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Smoking cannabis using a tobacco-derived cigar shell or wrap, called blunt smoking, exposes individuals to non-trivial amounts of nicotine. The extent smoking blunts impact the risk of initiating other tobacco products is not well understood. We investigated if past-year blunt smoking is related to the risk of initiating cigarettes, e-cigarettes, and cigars. METHODS We obtained data on a nationally representative, non-institutionalized, civilian cohort of US residents aged 12 years and older who had never used cigarettes, e-cigarettes, or any cigar at baseline and surveyed annually for three years from the Population Assessment of Tobacco and Health Study. We estimated the proportional hazard (odds) of initiating these tobacco products associated with past-year blunt smoking, non-blunt cannabis use, or neither using discrete-time survival analyses. RESULTS Smoking blunts increased the risk of starting cigarettes (OR = 4.5), e-cigarettes (OR = 3.7), and cigars (OR = 6.7) compared to using neither blunts nor cannabis. Non-blunt cannabis use also increased the risk of starting cigarettes (OR = 4.0) but moderately for e-cigarettes (OR = 2.8) and any cigar (OR = 2.2). Blunt use was strongly related to starting combustible tobacco (cigarettes or cigars; OR = 9.0) and any three tobacco products (OR = 10.9). Exploratory findings showed that cigarillos drove cigar results and effect modification by age, race/ethnicity, and sex. CONCLUSIONS People who smoke blunts risk starting cigarettes, e-cigarettes, and cigars more than those who abstain from cannabis. Blunts may contribute to tobacco initiation above cannabis alone.
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Affiliation(s)
- Brian J Fairman
- Department of Epidemiology, University of Arkansas for Medical Sciences, United States.
| | - Heather L Kimmel
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, United States
| | - Wilson M Compton
- Office of the Director, National Institute on Drug Abuse, National Institutes of Health, United States
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Young-Wolff KC, Adams SR, Brown QL, Weisner C, Ansley D, Goler N, Skelton KR, Satre DD, Foti TR, Conway A. Modes of cannabis administration in the year prior to conception among patients in Northern California. Addict Behav Rep 2022; 15:100416. [PMID: 35252535 PMCID: PMC8894140 DOI: 10.1016/j.abrep.2022.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022] Open
Abstract
Cannabis use among individuals before and during pregnancy is increasing alongside the proliferation of new products with various modes of administration. Preconception cannabis use is a strong predictor of prenatal cannabis use. Yet little is known about how individuals administer cannabis during the preconception period, particularly in socioeconomically vulnerable populations. This study examined the prevalence and correlates of modes of cannabis administration (smoke, vape, blunts, edible/oral, dabs/wax, lotion/topical) during the year before conception, among patients who self-reported preconception cannabis use during universal screening in prenatal care. Descriptive statistics included sociodemographic characteristics, preconception cannabis use frequency, and modes of administration. Chi-square tests examined whether mode was associated with sociodemographic characteristics and use frequency. The sample (N = 11,936, screened from February 2020-May 2021) was 59.8% non-White and 26.1% were < 26 years old; 50.7% reported monthly or less, 21.8% weekly, and 27.4% daily preconception cannabis use; 69.7% smoked (any method), 34.5% smoked blunts, 53.4% used edibles/oral, 28.2% vaped, 9.9% used lotion/topical; 54.2% reported 1 mode, 30.4% reported 2 modes, 15.4% reported 3+ modes. Smoking was more common among daily users, younger patients, those with greater neighborhood deprivation, and Black and Hispanic patients, while edibles/oral were more common among ≤ monthly users, older patients, those with less neighborhood deprivation, and Asian patients. Use of other modes also varied by sociodemographic characteristics and use frequency. Research is needed to understand preconception cannabis use in vulnerable subpopulations, continuation of use during pregnancy, and whether health risks associated with preconception and prenatal cannabis use differ by administration mode.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Qiana L Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kara R Skelton
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Tara R Foti
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland, CA, USA
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Cohn AM, Chen S. Age groups differences in the prevalence and popularity of individual tobacco product use in young adult and adult marijuana and tobacco co-users and tobacco-only users: Findings from Wave 4 of the population assessment of tobacco and health study. Drug Alcohol Depend 2022; 233:109278. [PMID: 35151023 PMCID: PMC9028208 DOI: 10.1016/j.drugalcdep.2022.109278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tobacco use is high among marijuana and tobacco users, compared to tobacco-only users. This study examined the relative ranking (based on prevalence) of past 30-day tobacco product use separately across young adult and older adult past 30-day marijuana and tobacco co-users and tobacco-only users. METHOD Prevalence and relative ranking of past 30-day use of eight different tobacco products and blunts were examined in young adult (ages 18-24) and adults (ages 25 +) tobacco users who did and did not report past 30-day marijuana use (unweighted n = 33,644) from Wave 4 of the Population Assessment of Tobacco and Health study. Multiple logistic regressions examined increased odds of using each product in the past 30-days by marijuana and tobacco co-use. RESULTS Nearly half (47.9%) of past 30-day young adult tobacco users reported past 30-day marijuana use (e.g., co-use); 27.7% of adult tobacco users reported past 30-day co-use. Cigarettes were the most popular product used in the past 30-days across tobacco-only and co-users of both age groups. Rankings of all other tobacco products differed between the age groups. Among young adult co-users, blunts were ranked the second most popular product used in the past 30-days, followed by e-cigarettes, and then cigarillos/filtered cigars. Among adult co-users, blunts were ranked the fourth most popular product used in the past 30-days. Adult co-users reported significantly higher prevalence of past 30-day use of all combustible products compared to tobacco only users. CONCLUSIONS Co-users may be at increased risk of health consequences given high rates of combustible tobacco use.
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Affiliation(s)
- Amy M Cohn
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, Suite 14000, Oklahoma City, OK 73104, USA; TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 800 N.E. 13th Street, Oklahoma City, OK 73104, USA.
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Grobman B, Wu R, Jackson A, Bold KW, Morean ME, Camenga DR, Davis DR, Simon P, Krishnan-Sarin S, Kong G. First tobacco product tried among adolescents based on race/ethnicity and socioeconomic status. Addict Behav 2021; 113:106666. [PMID: 33130462 DOI: 10.1016/j.addbeh.2020.106666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/31/2020] [Accepted: 09/16/2020] [Indexed: 12/27/2022]
Abstract
In recent years, the tobacco use landscape among youth has changed greatly, underscoring a need to understand current tobacco product initiation patterns. This study aimed to examine if adolescents' first tobacco product tried differs by race/ethnicity and socioeconomic status (SES). Cross-sectional survey data were collected from 6 Connecticut high schools in Spring 2019 (N = 4875). The analytic sample comprised ever users of tobacco products who reported on the first tobacco product they tried (N = 2530; 53.6% female). Of ever tobacco product users, 64.6% reported that their first tobacco product tried was an e-cigarette, 24.4% reported blunts, 6.5% reported another tobacco product, and 4.5% reported cigarettes. A multinomial logistic regression model examined race/ethnicity and SES as predictors of the first tobacco product tried with cigarettes as the reference group. Compared to Non-Hispanic (NH) White students, NH Black students (OR = 0.38, 95%CI = 0.17-0.82), Hispanic students (OR = 0.44, 95%CI = 0.27-0.71), and students of other NH races (OR = 0.30, 95%CI = 0.18-0.52) were less likely to report initiating tobacco product use with e-cigarettes. Additionally, compared to NH White students, NH Black students were more likely to report using blunts as their first tobacco product (OR = 3.01, 95%CI = 1.38-6.56). Compared to low SES, middle SES (OR = 1.62, 95%CI = 1.04-2.52) was associated with greater odds of reporting e-cigarettes as the first tobacco product. These findings suggest that youth of different backgrounds initiate tobacco use with different tobacco products and tailored prevention strategies are needed.
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Montgomery L, Plano Clark VL, Twitty D, Budney AJ, Prochaska JJ, Winhusen T. Is it "loud" enough?: A qualitative investigation of blunt use among African American young adults. J Ethn Subst Abuse 2020; 21:747-761. [PMID: 32744476 DOI: 10.1080/15332640.2020.1801548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
| | | | - Dylanne Twitty
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Montgomery L, McClure EA, Tomko RL, Sonne SC, Winhusen T, Terry GE, Grossman JT, Gray KM. Blunts versus joints: Cannabis use characteristics and consequences among treatment-seeking adults. Drug Alcohol Depend 2019; 198:105-111. [PMID: 30901744 PMCID: PMC6467739 DOI: 10.1016/j.drugalcdep.2019.01.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/03/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite the high prevalence of blunt smoking among cannabis users, very few studies examine the clinical profile of blunt smokers relative to those using more common methods of cannabis use, such as joints. METHODS The current study uses baseline data from the ACCENT (Achieving Cannabis Cessation-Evaluating N-acetylcysteine Treatment) study, a multi-site randomized pharmacotherapy clinical trial within the National Drug Abuse Treatment Clinical Trials Network, to predict the association between blunt and joint use frequency and cannabis use characteristics (e.g., grams of cannabis used) and consequences (e.g., withdrawal) among past-month cannabis users (N = 377) who were screened for study participation. RESULTS After controlling for race, age, gender, other forms of cannabis use (including joint use) and nicotine dependence, multivariable linear regression models indicated that the number of days of blunt use in the past month was a significant predictor of the average amount of cannabis per using day (t = 3.04, p < .01), the estimated average cost of cannabis (t = 2.28, p < .05) and Cannabis Withdrawal Scale scores (t = 1.94, p < .05). Frequency of joint use did not significantly predict any of the cannabis use characteristics or consequences. CONCLUSIONS Blunt smokers may present to treatment with greater amounts of cannabis smoked and more intense withdrawal symptoms, which may adversely impact their likelihood of successful abstinence. Cannabis-dependent blunt smokers may be more likely to benefit from treatment that targets physiological and mood-related withdrawal symptoms.
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Affiliation(s)
- LaTrice Montgomery
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Susan C. Sonne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
| | - Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH 45229, USA
| | - Garth E. Terry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Jason T. Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Integrated Substance Abuse Programs, 11075 Santa Monica Blvd Ste 200, Los Angeles, CA 90025, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA
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Abstract
Background Blunts are partially or fully hollowed-out cigars or cigarillos that are filled with marijuana. Despite the high prevalence of blunt use, very few studies assess this specific method of cannabis administration. YouTube, a popular video-sharing website, has the potential to provide insights into blunt use. Methods The purpose of this study was to examine the content of YouTube videos that discuss blunts. A sample of 41 videos was coded for content. Results The 41 videos had a total of 27,579,636 views. Most of the individuals in the videos were male (85%) and many appeared to be White (80%) and under the age of 25 (46%). Only 34% of the videos had an age restriction. The majority of messages in the videos promoted blunt use (93%) and showed at least one person rolling (76%) and/or smoking (66%) a blunt. The videos mainly consisted of introductions to blunt use (76%) and tips and personal experiences with blunt use (73%). Conclusions YouTube videos on blunt use are readily available and primarily promote the use of blunts. Future research should continue to monitor YouTube content and develop videos on social media platforms that inform consumers of the health effects associated with blunt use.
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Affiliation(s)
- LaTrice Montgomery
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew Yockey
- Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Schauer GL, Rosenberry ZR, Peters EN. Marijuana and tobacco co-administration in blunts, spliffs, and mulled cigarettes: A systematic literature review. Addict Behav 2017; 64:200-211. [PMID: 27654966 DOI: 10.1016/j.addbeh.2016.09.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
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.
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11
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Peters EN, Schauer GL, Rosenberry ZR, Pickworth WB. Does marijuana "blunt" smoking contribute to nicotine exposure?: Preliminary product testing of nicotine content in wrappers of cigars commonly used for blunt smoking. Drug Alcohol Depend 2016; 168:119-122. [PMID: 27639129 DOI: 10.1016/j.drugalcdep.2016.09.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION An increasingly popular method of consuming marijuana is through the smoking of "blunts," cigar products in which some or all of the tobacco filler is removed and repacked with marijuana. Even if all tobacco filler is removed from the cigar product in the process of making blunts, nicotine may be present in the wrapper of the cigar product. This preliminary analysis quantified the nicotine content in wrappers of cigar products commonly used for blunt smoking. METHODS Five cigar products (3 large cigars, 2 cigarillos) were tested, yielding physical characteristics of cigar length, diameter, weight, and wrapper weight. Nicotine concentration in the wrapper of each cigar product was analyzed via gas chromatography/mass spectrometry. Total nicotine content in the wrapper of each cigar product was computed as the product of cigar wrapper weight and nicotine concentration in wrapper. RESULTS Depending on the product, the cigar wrapper contributed between 8 and 18% of the weight of the entire cigar article. Total nicotine content in the cigar wrapper ranged from 1.2 to 6.0mg per cigar. DISCUSSION All 5 tested cigar products had wrappers that contain quantifiable levels of nicotine, indicating that users of blunts may expose themselves to some degree of nicotine, the addictive component of tobacco. Future experimental studies that examine the efficiency of nicotine delivery from typical blunt smoking, as well as surveillance studies that quantify the number of blunts smoked by an individual per day, are needed to evaluate the contribution of blunt smoking to nicotine dependence.
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Affiliation(s)
- Erica N Peters
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, USA.
| | - Gillian L Schauer
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 1100 Dexter Avenue North, Suite 400, Seattle, WA 98109-3598, USA; Health Services Department, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Zachary R Rosenberry
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, USA
| | - Wallace B Pickworth
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, 6115 Falls Road, Suite 200, Baltimore, MD, USA
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Abstract
INTRODUCTION Cannabis and tobacco are the most widely used substances, and are often used together. The present review examines the toxicant exposure associated with co-use (e.g., carbon monoxide, carcinogens), co-use via electronic nicotine delivery systems (ENDS), and problematic methodological issues present across co-use studies. METHOD An extensive literature search through PubMed was conducted and studies utilizing human subjects and in vitro methods were included. Keywords included tobacco, cigarette, e-cigarette, ENDS, smoking, or nicotine AND marijuana OR cannabis OR THC. RESULTS Co-use may pose additive risk for toxicant exposure as certain co-users (e.g., blunt users) tend to have higher breath carbon monoxide levels and cannabis smoke can have higher levels of some carcinogens than tobacco smoke. Cannabis use via ENDS is low and occurs primarily among established tobacco or cannabis users, but its incidence may be increasing and expanding to tobacco/cannabis naïve individuals. There are several methodological issues across co-use research including varying definitions of co-use, sample sizes, lack of control for important covariates (e.g., time since last cigarette), and inconsistent measurement of outcome variables. CONCLUSIONS There are some known additive risks for toxicant exposure as a result of co-use. Research utilizing consistent methodologies is needed to further establish the additive risk of co-use. Future research should also be aware of novel technologies (e.g., ENDS) as they likely alter some toxicant exposure when used alone and with cannabis.
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Affiliation(s)
- Ellen Meier
- University of Minnesota, Department of Psychiatry, Tobacco Research Programs, United States.
| | - Dorothy K Hatsukami
- University of Minnesota, Department of Psychiatry, Tobacco Research Programs, United States
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Cohn A, Johnson A, Ehlke S, Villanti AC. Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health. Drug Alcohol Depend 2016; 160:105-11. [PMID: 26803718 DOI: 10.1016/j.drugalcdep.2015.12.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/14/2015] [Accepted: 12/19/2015] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Amy Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA; Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, USA.
| | - Amanda Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Sarah Ehlke
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Koopman Gonzalez SJ, Cofie LE, Trapl ES. "I just use it for weed": The modification of little cigars and cigarillos by young adult African American male users. J Ethn Subst Abuse 2015; 16:66-79. [PMID: 26643132 DOI: 10.1080/15332640.2015.1081117] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Sarah J Koopman Gonzalez
- a Department of Epidemiology & Biostatistics , Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University , Cleveland , Ohio
| | - Leslie E Cofie
- b Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina , Chapel Hill , North Carolina
| | - Erika S Trapl
- a Department of Epidemiology & Biostatistics , Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University , Cleveland , Ohio
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Fairman BJ. Cannabis problem experiences among users of the tobacco-cannabis combination known as blunts. Drug Alcohol Depend 2015; 150:77-84. [PMID: 25746234 PMCID: PMC4387065 DOI: 10.1016/j.drugalcdep.2015.02.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In most of the world, cannabis smokers mix loose tobacco inside a joint, pipe, spliff, or cone. More recently, a 'blunt' formulation combines these two drugs by inserting cannabis into a hollowed-out cigar. Epidemiological research linking simultaneous use of these two drugs and the development of cannabis use disorders (CUD) remains unclear. This study estimates associations linking blunt smoking with levels and subtypes of cannabis problems. METHODS Cross-sectional data on 27,767 past-year cannabis users were analyzed from the US National Survey on Drug Use and Health (NSDUH) conducted from 2009 to 2012. Ten self-reported items of DSM-IV CUD features elicited a single latent trait of cannabis problem (CP) severity, which was then regressed on past-year blunt smoking and past-month blunt frequency measures within the context of a conceptual model. Differential item functioning (DIF) analysis evaluated potential bias in CP feature response by blunt smoking history. RESULTS Past-year blunt smoking was associated with higher CP severity compared to cannabis users who did not smoke blunts. Days of blunt smoking in the past month also predicted higher CP severity than less frequent blunt use. Those smoking blunts experienced more subjectively felt tolerance and having spent more time obtaining or using cannabis, but were less likely to experience other problems, even at the same level of CP severity. CONCLUSIONS These findings suggest smoking blunts might promote the development of problematic cannabis use. Responses to cannabis problems differed by history of blunt smoking, possibly implicating an influence of tobacco on measurement of cannabis use disorders.
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Affiliation(s)
- Brian J. Fairman
- Department of Mental Health, John Hopkins Bloomberg School of Public Health, 624 North Broadway, 8th Floor, Baltimore, MD 21205 , Phone: (410) 347-3211, Fax: (410) 614-7569
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Lipperman-Kreda S, Juliet PL, Morrison C, Bridget F. Availability of tobacco products associated with use of marijuana cigars ( blunts). Drug Alcohol Depend 2014; 134:337-342. [PMID: 24290366 PMCID: PMC3883305 DOI: 10.1016/j.drugalcdep.2013.10.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/25/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Sharon Lipperman-Kreda
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, United States.
| | - P. Lee Juliet
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, Fax: (510) 644-0594, Phone: (510) 883-5750
| | - Chris Morrison
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, Fax: (510) 644-0594, Phone: (510) 883-5750,Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Freisthler Bridget
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612, Fax: (510) 644-0594, Phone: (510) 883-5750,UCLA School of Public Affairs, Department of Social Welfare, Los Angeles, CA
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