Integrating Use Frequency, Vaping, and Dependence to Characterize Nicotine-Cannabis Co-Use in Young Adults: A Latent Class Analysis.

Jacobs W.; Peck M.; Parker M. · Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026

**Background & Methods** This latent class analysis examined pooled data from the 2022-2023 National Survey on Drug Use and Health (NSDUH) in 14,500 U.S. young adults aged 18-29 who reported tobacco/nicotine or cannabis use. The analysis identified distinct subgroups based on past 30-day tobacco use frequency, nicotine vaping frequency, cannabis use frequency, nicotine dependence (measured by Nicotine Dependence Syndrome Scale), and cannabis use disorder (DSM-5 criteria). **Key Findings** • Four distinct behavioral phenotypes of nicotine-cannabis co-use were identified: nicotine-dominant use (38.6%), characterized by high tobacco use with minimal cannabis involvement; low co-use (17.4%), with the lowest levels of all substance use and dependence measures; cannabis-dominant co-use (32.3%), featuring near-daily cannabis use with relatively low tobacco/nicotine involvement; and high-frequency co-use (11.7%), marked by frequent use of both nicotine products and cannabis with elevated dependence indicators. • Serious psychological distress was associated with nearly twice the risk of cannabis-dominant co-use compared to nicotine-dominant use, suggesting mental health factors influence co-use patterns. • The predominance of three distinct co-use classes (61.4% of the sample) demonstrates that tobacco-cannabis polysubstance use represents a heterogeneous phenomenon requiring differentiated intervention strategies rather than uniform prevention approaches. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study represents observational cross-sectional research with moderate-to-good evidence quality. Strengths include use of a large, nationally representative sample and application of latent class analysis to identify meaningful behavioral subtypes. The incorporation of validated instruments (Nicotine Dependence Syndrome Scale and DSM-5 criteria) enhances reliability. Limitations include reliance on self-reported data, inability to establish causality, cross-sectional design precluding temporal relationships, and lack of information on specific cannabis and nicotine product types beyond vaping status. The study does not assess mechanistic underpinnings of co-use or long-term health consequences. Results are generalizable primarily to U.S. young adults and may not reflect patterns in other age groups or geographic regions.

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