Self-Report of Cannabis Dispensaries in Neighborhoods and Tobacco and Cannabis Co-Use among US Adults.

de Jesus Navarro Barba J.; Keyhani S.; Hoggatt K.; Ling P.; Hasin D.; Nguyen N.; Pravosud V.; Graham F.; Cohen B. · Journal of studies on alcohol and drugs · 2026

**Background & Methods** This cross-sectional web-based survey examined the association between self-reported awareness of cannabis dispensaries in residential neighborhoods and tobacco-cannabis co-use among US adults. The study enrolled 1,929 participants over 18 years old with past 30-day tobacco use (cigarettes or e-cigarettes) residing in states with legal medical or non-medical cannabis, surveyed in November 2023 using the Ipsos KnowledgePanel (a nationally representative probability-based panel). Weighted multivariable logistic regression models estimated adjusted associations between dispensary awareness and concurrent tobacco-cannabis co-use (defined as past 30-day use of both substances). **Key Findings** • Self-reported awareness of a cannabis dispensary in the neighborhood was associated with nearly twice the odds of tobacco-cannabis co-use compared to no awareness (adjusted OR 1.80, 95% CI 1.33-2.44), independent of sociodemographic factors. • The dispensary awareness-co-use association was statistically significant for smoked cannabis (p<.001), vaped cannabis (p<.001), and edible cannabis products (p=.003), but not for cannabis concentrates (p=.11). • This finding highlights that proximity/awareness of cannabis retail locations is independently associated with increased concurrent tobacco-cannabis use, suggesting environmental and behavioral factors beyond individual demographics drive co-use patterns. **Dosage & Administration** Not reported. **Safety & Adverse Effects** The abstract notes that tobacco-cannabis co-use "may pose increased health risks compared to single product use" but does not specify particular adverse effects. Direct health outcomes were not measured in this survey-based study. **Evidence Quality** This is a cross-sectional survey with significant limitations: reliance on self-reported awareness of dispensaries (rather than objective geographic data), cross-sectional design preventing causal inference, restriction to current tobacco users (selection bias), and inability to determine whether dispensary proximity causes co-use or represents confounding by neighborhood characteristics. The study provides observational evidence (Grade C) suggesting an association but cannot establish causality. The large representative sample and adjustment for sociodemographic confounders strengthen the findings. Publication in 2026 suggests contemporary data, though the November 2023 data collection precedes publication.

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