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Is Cannabis Use Associated With Increased Risk of Cigarette Smoking Initiation, Persistence, and Relapse? Longitudinal Data From a Representative Sample of US Adults

J Clin Psychiatry 2018;79(2):17m11522

Objective: The current study prospectively investigated the relationship between cannabis use and cigarette smoking initiation, persistence, and relapse during a 3-year period among adults in the United States.

Methods: Analyses included respondents who completed Waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions and responded to questions about cannabis use and smoking status (n = 34,639). Multivariable logistic regression models were used to calculate the odds of cigarette use at Wave 2 among Wave 1 daily smokers, nondaily smokers, former smokers, and nonsmokers by Wave 1 cannabis use.

Results: In unadjusted analyses, Wave 1 cannabis use was associated with increased odds of Wave 2 daily and nondaily smoking for Wave 1 nonsmokers (daily OR = 2.90; 95% CI, 2.10–4.00; nondaily OR = 4.45; 95% CI, 3.97–5.00) and Wave 2 relapse to daily and nondaily smoking for Wave 1 former smokers (daily OR = 4.18, 95% CI, 3.01–5.81; nondaily OR = 5.24; 95% CI, 3.74–7.34). Wave 1 cannabis use was associated with decreased odds of Wave 2 smoking cessation for Wave 1 daily cigarette smokers (OR = 0.57; 95% CI, 0.51–0.64). The associations remained significant for daily smoking initiation (OR = 1.43; 95% CI, 1.06–1.93), daily smoking relapse (OR = 1.47; 95% CI, 1.00–2.16), and smoking cessation (OR = 0.77; 95% CI, 0.69–0.87) after adjusting for demographics and psychiatric disorders. Associations remained significant for nondaily smoking initiation (OR = 1.85; 95% CI, 1.59–2.16) and nondaily smoking relapse (OR = 1.63; 95% CI, 1.05–2.54) after adjusting for these covariates as well as for alcohol and substance use disorders.

Conclusions: Cannabis use was associated with increased initiation of, persistence of, and relapse to cigarette smoking. Additional attention to cannabis use in tobacco control efforts and in clinical settings aimed at reducing cigarette smoking and smoking-related negative consequences may be warranted.