Tobacco products, particularly cigars, little cigars, and cigarillos (CLCC), as well as electronic nicotine vaping devices, are commonly used as cannabis delivery methods. Blunts—products where tobacco is partially or fully replaced with cannabis—are an especially popular mode of cannabis use among youth and young adults. Compared to users of other cannabis products, blunt users tend to initiate cannabis use at a younger age, report more frequent use, and face higher rates of cannabis use disorders, tobacco dependency, respiratory problems, and concurrent alcohol and other drug use. Despite these public health concerns, few studies have comprehensively examined characteristics associated with blunt use frequency among youth and young adults. Therefore, the present study explores sociodemographic, behavioral, and attitudinal characteristics associated with blunt use frequency among 15-24-year-old residents of New York, which legalized recreational cannabis in 2021.
The study surveyed 466 New York-based youth and young adults (ages 15-24) who reported past-year blunt use. Participants were categorized into use groups based on their past-year CLCC and blunt use patterns. Survey items, adapted from the PATH study Wave 6 and the New York Adult Tobacco Survey, assessed blunt use frequency (categorized as none, light [1-3 days], moderate [4-11 days], or frequent [12-30 days] in the past 30 days), current dual use status (no current use, blunt-only use, or dual CLCC and blunt use), and various knowledge, attitudes, and beliefs (KAB) measures including perceived addictiveness of blunts, perceived prevalence of peer blunt use (standardized as a z-score), and awareness that blunt wrappers contain nicotine. Additional covariates included demographic characteristics (race/ethnicity, sex at birth, age group), other tobacco product use in the past 30 days (excluding CLCC), frequency of mixing tobacco with cannabis, and frequency of using flavored blunts. Multinomial logistic regression models were employed to examine associations between study measures and both blunt use frequency and current dual use status.
According to the findings, several factors were significantly associated with blunt use frequency and dual use status. Dual users showed significantly higher relative risk of using blunts 4-11 days and 12-30 days per month compared to blunt-only users. Lack of awareness that blunt wraps contain nicotine was associated with higher relative risk of blunt use across all frequency categories and dual use status. Higher perceived prevalence of peer blunt use was associated with increased relative risk of moderate to frequent blunt use (4-30 days) and dual use. Past-30-day use of other (non-CLCC) tobacco products was strongly associated with higher relative risk of all blunt use frequencies and dual use patterns. Respondents who never used flavored blunts had lower relative risk of all blunt use frequencies and were less likely to be dual users or blunt-only users. Never mixing cigar tobacco in blunts was associated with lower relative risk of moderate blunt use (4-11 days) and dual use. Older age (21-24 years) was associated with higher relative risk of current dual use. Notably, no significant associations were found between blunt use patterns and race/ethnicity, sex at birth, or perceived addictiveness of blunts.
Takeaway: Dual users showed higher blunt use frequency, and modifiable factors such as nicotine knowledge gaps, tobacco mixing, and flavored blunt preferences present key intervention targets to address nicotine dependency risk among youth and young adults.