Concurrent Use of Tobacco and Cannabis and Internalizing and Externalizing Problems in US Youths.

The prevalence of concurrent use of tobacco and cannabis (3.4%) in this study seemed to be lower compared with 5.4% among youths in 2014 from the NSDUH data 3 or 12.4% among middle and high school students in California in 2019, 38 which is consistent with a decreasing trend in tobacco and cannabis use observed among youths in recent years. 1 , 39 , 40 , 41 The lower prevalence of tobacco, cannabis use, and concurrent use reported in 2021 could also be a temporary drop due to the impact of the COVID-19 pandemic (eg, effects of lockdown or disrupted supply chains). 42 , 43 Studies have shown that tobacco and cannabis can be a gateway or reverse gateway for each other, 44 and as a consequence, a rise in the use of one substance could lead to an increase in the concurrent use of both substances.

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