Cannabis use and route-specific administration among U.S. adults who do and do not use tobacco: Findings from the 2024 Health Information National Trends Survey.

Wilsnack C.; Gibson L.; Ciccolo J.; Lee Y.; Mayne R.; Kaufman A. · Addictive behaviors · 2026

**Background & Methods** This cross-sectional study analyzed nationally representative data from the 2024 Health Information National Trends Survey (N=6,328) to examine prevalence and route-specific cannabis use patterns stratified by tobacco use status. Multivariable logistic regression models assessed associations between current tobacco use and past 12-month cannabis use, adjusting for state-level cannabis legality, reasons for use, and sociodemographic factors. **Key Findings** • Overall cannabis use prevalence among U.S. adults was 23.1% in the past 12 months, with smoking (62.6%), consumption (57.6%), and vaping (40.1%) as the most common routes; over half of users (52.7%) reported using multiple administration routes. • Adults with current tobacco use reported significantly higher cannabis prevalence (46.0%) compared to non-tobacco users (17.4%), representing nearly a twofold difference (p<0.001). • Among cannabis users, those with current tobacco use were significantly more likely to smoke cannabis (73.4% vs. 55.6%, p=0.001), vape cannabis (52.4% vs. 32.1%, p<0.001), or employ multiple routes of administration (60% vs. 47.9%, p=0.02) compared to non-tobacco users. **Dosage & Administration** Not reported. The study documented routes of administration (smoking, vaping, dabbing, edible consumption, topical lotion application) and polyroute use patterns but did not include quantitative dosing information. **Safety & Adverse Effects** Not reported. The study focused on prevalence and administration patterns without assessing adverse health effects, safety outcomes, or toxicological impacts of cannabis use or cannabis-tobacco co-use. **Evidence Quality** Strengths include use of nationally representative data and adjustment for relevant confounders including state-level legality and sociodemographic characteristics. Limitations include the cross-sectional design, which precludes causal inference; reliance on self-reported data susceptible to recall and social desirability bias; and lack of detailed information on frequency, quantity, or potency of use. The study provides moderate-quality observational evidence (Level 3). The authors appropriately note the need for continued surveillance and prospective research to elucidate health effects of cannabis-tobacco co-use patterns.

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