Tobacco and cannabis use remains prevalent among U.S. teenagers, with 7.3% and 6.4% reporting use in the past 30 days, respectively. The 2022 National Survey on Drug Use and Health (NSDUH) highlights that 5.4% of teens use both substances concurrently, surpassing the rates of exclusive use of either. These figures, however, do not account for the rising use of electronic cigarettes and vaporized cannabis.
Rising Concern and Need for Updated Research
As the use of these newer products increases, updated data and further research are vital to understanding their impact on youth mental health. This information is crucial for guiding public health efforts.
About the PATH Study
The Population Assessment of Tobacco and Health (PATH) Study is a comprehensive, longitudinal study of U.S. adults and youths aged 12 and older. Baseline data were collected from January 2013 to December 2014.
The PATH study initially included 45,971 participants and 7,207 ‘shadow youths’ aged nine to 11. In wave four, an additional 14,098 participants were added. Wave six, conducted from March to November 2021, included 5,652 youths aged 14 to 17.
Mental Health Assessment
Mental health problems were measured using the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), which assesses internalizing issues like anxiety and depression and externalizing behaviors such as impulsivity and aggression.
Participants were categorized into four groups: non-users, tobacco-only users, cannabis-only users, and concurrent users. Factors like age, sex, race, parental education, and other substance use were considered in the analysis.
Findings from the Study
The current study involved 5,585 participants, with a nearly equal gender distribution. About 27.5% were 14 years old, while 72.5% were between 15 and 17. Over 75% had at least one parent with some college education or higher. The cohort was ethnically diverse: 26% Hispanic, 12.7% non-Hispanic Black, 50.5% non-Hispanic White, and 11% non-Hispanic other.
Regarding substance use in the past 30 days, 4% reported using tobacco, 2.5% reported using cannabis, and 3.4% reported using both. Additionally, 9.1% used alcohol in the past 30 days, and 4.9% used other substances in the past year.
Mental Health Issues Among Users
Internalizing problems were reported by 28.4% of participants at moderate levels and by 24.6% at high levels. Externalizing problems were reported at moderate and high levels by 30.7% and 32.5%, respectively.
Mental health issues were more prevalent among tobacco and cannabis users compared to non-users. High levels of internalizing problems were reported by 47.4% of concurrent users, 44.8% of cannabis-only users, 41.4% of tobacco-only users, and 22.4% of non-users. For externalizing problems, 61.6% of concurrent users reported high levels, compared to 48.5% of cannabis-only users, 46.3% of tobacco-only users, and 30.4% of non-users.
Adjusted Risk Factors
After adjusting for covariates, the likelihood of higher internalizing problems was significantly greater for concurrent users, tobacco-only users, and cannabis-only users compared to non-users, with adjusted odds ratios (AORs) of 2.32, 1.95, and 2.32, respectively. No significant differences were observed between concurrent and single-substance users in internalizing problems.
For externalizing issues, AORs were 3.10 for concurrent users, 1.69 for tobacco-only users, and 1.68 for cannabis-only users compared to non-users. Concurrent users were almost twice as likely to report externalizing problems as single-substance users, with AORs of 1.83 and 1.85, respectively.
Additional Findings
A greater likelihood of both internalizing and externalizing problems was associated with being female, having used alcohol in the past 30 days, and having used other substances in the past 12 months. Younger participants (14 years old) and those with parents with higher education levels were more likely to experience externalizing problems. Non-Hispanic Black and Hispanic youths reported fewer mental health problems compared to their White peers.
Conclusion
Concurrent use of tobacco and cannabis among teens is as common as tobacco-only use and more common than cannabis-only use. Those using both substances report the highest levels of mental health issues. The findings underscore the need for integrated prevention and treatment programs that address both substance use and mental health, especially in the wake of the COVID-19 pandemic.
