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. 2020 May:79:102754.
doi: 10.1016/j.drugpo.2020.102754. Epub 2020 Apr 16.

International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey

Shannon Gravely  1 , Pete Driezen  2 , Danielle M Smith  3 , Ron Borland  4 , Eric N Lindblom  5 , David Hammond  6 , Ann McNeill  7 , Andrew Hyland  3 , K Michael Cummings  8 , Gary Chan  9 , Mary E Thompson  10 , Christian Boudreau  10 , Nadia Martin  11 , Janine Ouimet  11 , Ruth Loewen  11 , Anne C K Quah  11 , Maciej L Goniewicz  3 , James F Thrasher  12 , Geoffrey T Fong  13
Affiliations

International differences in patterns of cannabis use among adult cigarette smokers: Findings from the 2018 ITC Four Country Smoking and Vaping Survey

Shannon Gravely et al. Int J Drug Policy. 2020 May.

Abstract

Background: Although evidence shows that co-use of cigarettes and cannabis is common, there is little research examining if co-use patterns vary depending on the regulatory environment for cannabis. This study examined patterns of co-use and perceptions of relative harm among cigarette smokers in four countries with different histories, and at different stages of cannabis legalization.

Methods: Data are from the 2018 International Tobacco Control 4CV Survey and included 10035 adult cigarette smokers from Canada, United States (US), Australia, and England. At the time of the survey, Canada and the US had relatively more permissive cannabis regulations compared to Australia and England.

Results: Among this sample of 10035 cigarette smokers, Canada had the highest rate of cannabis co-use in the last 12 months (36.3%), followed by the US (29.1%), England (21.6%), and Australia (21.4%). Among past 12 month co-users (n = 3134), the US (40.2%) and Canada (35.2%) had the highest rates of daily cannabis use, followed by smokers in England (26.3%) and Australia (21.7%); Australian co-users had the highest rate of infrequent (<monthly) cannabis use. The highest proportion of co-users who smoked daily and used cannabis daily was in the US (34.8%), followed by Canada (30.6%), England (25.8%), and Australia (22.7%). More co-users in the US (78.3%) and Canada (73.6%) perceived smoked cannabis to be less harmful than cigarettes than in Australia (65.5%) and England (60.8%). The majority of co-users who used cannabis in the last 30 days had smoked it (92.3%), with those in England more likely to smoke cannabis (95.7%) compared to Canada (88.6%); there were no other differences between countries (US: 92.0%, Australia: 93.0%). Co-users in England (90.4%) and Australia (86.0%) were more likely to mix tobacco with cannabis than co-users in Canada (38.5%) and the US (22.3%).

Conclusion: Patterns of tobacco and cannabis co-use differed between countries. Smokers in Canada and the US had higher rates of co-use, daily cannabis use, dual-daily use of both cannabis and cigarettes, and were more likely to perceive smoked cannabis as less harmful than cigarettes compared to England and Australia. Further attention as to how varying cannabis regulations may impact co-use patterns is warranted.

Keywords: Cannabis; Co-use; Harm Perceptions; Policy; Regulation; Tobacco cigarettes.

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Conflict of interest statement

Declaration of Competing Interest KMC has received payment as a consultant to Pfizer, Inc., for service on an external advisory panel to assess ways to improve smoking cessation delivery in health care settings. KMC also has served as paid expert witness in litigation filed against the tobacco industry. GTF, DH, and JFT have served as expert witnesses on behalf of governments in litigation involving the tobacco industry. MLG has received a research grant from Pfizer and served as a member of scientific advisory board to Johnson & Johnson. AM is a UK National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the UK Department of Health and Social Care. All other authors have no conflicts of interest to declare.

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