Understanding commercial tobacco and Cannabis co-use in American Indian young adults in California.

Llanes K.; Cobian P.; Boogaard J.; Ling P.; Koester K.; Islam S.; Ramos G.; Keller S.; Soto C. · Addictive behaviors reports · 2026

**Background & Methods** This qualitative study examined commercial tobacco and cannabis co-use patterns among 52 American Indian young adults (ages 21-29) in California who were current users of both substances. Researchers conducted in-depth interviews between 2023 and 2024 as part of a community-engaged research initiative to understand the contexts, motivations, and patterns of concurrent product use in this disproportionately affected population. **Key Findings** • Participants co-used commercial tobacco and cannabis to achieve tailored psychoactive effects, combining nicotine's stimulant properties (alertness) with cannabis's relaxing effects to meet specific situational needs. • Social factors significantly influenced co-use patterns, with participants reporting intentional use of products like vapes and blunts to facilitate bonding and social connection; products were frequently shared among peers through communal device use or multiple hits from the same item. • Co-use routines were contextually dependent, varying based on daily responsibilities (caregiving, work obligations), consideration for public environments, and economic factors, with some participants identifying mixed tobacco-cannabis use as a cost-saving strategy. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This qualitative review demonstrates limited evidence quality for causal or safety conclusions. Significant limitations include the small sample size (N=52), geographic restriction to California, and cross-sectional interview design that cannot establish temporal relationships or causation. The study relies on self-reported data without biochemical verification of substance use. As a qualitative study without control groups or objective outcome measures, it provides descriptive understanding of user perspectives and behaviors but cannot quantify health risks or comparative effectiveness of interventions. The findings are hypothesis-generating rather than confirmatory. The authors appropriately recommend future interventions address identified factors (cravings, environmental cues, social contexts) and promote alternative coping strategies, suggesting recognition that additional research is needed before implementing evidence-based interventions targeting this population.

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