Wura Jacobs

Introduction: Tobacco and cannabis co-use is an increasingly complex public health challenge shaped by rapid expansion of vaping technologies and product diversity. To inform prevention and intervention efforts, behavioral typologies that incorporate use frequency, vaping, dependence/disordered use indicators are needed. Methods: We analyzed pooled 2022–2023 National Survey on Drug Use and Health data from 14, 500 U.S. young adults aged 18–29 who reported tobacco/nicotine or cannabis use. Latent class analysis identified subgroups based on past 30-day tobacco use frequency, nicotine vaping frequency, cannabis use frequency, nicotine dependence (Nicotine Dependence Syndrome Scale), and cannabis use disorder (Diagnostic and Statistical Manual of Mental Disorders-5 criteria). Results: A four-class model optimally balanced fit and interpretability. The largest subgroup was the nicotine-dominant use class (38.6%), marked by high tobacco use and minimal cannabis involvement. Three distinct co-use classes were identified: low co-use (17.4%), characterized by the lowest levels of tobacco product use, nicotine vaping, and cannabis use and comparatively low nicotine dependence and cannabis use disorder; cannabis-dominant co-use (32.3%), characterized by near-daily cannabis use with relatively low tobacco product use, nicotine vaping, and nicotine dependence; and high-frequency co-use (11.7%), characterized by frequent use of both nicotine products and cannabis and elevated nicotine dependence and cannabis use disorder. Serious psychological distress was associated with nearly twice the risk of cannabis-dominant co-use relative to nicotine-dominant use. Conclusion: Incorporating use frequency, vaping behaviors, and validated dependence and disordered use measures revealed distinct, tobacco-cannabis co-use behavioral phenotypes among young adults. Findings underscore the need for integrated prevention and cessation approaches tailored to heterogeneous co-use patterns. Implications: Using latent class analysis, we identified four distinct behavioral profiles, further demonstrating that tobacco/nicotine and cannabis co-use among young adults is not adequately captured by binary co-use measures or product use frequency alone. Incorporating validated measures of nicotine dependence and cannabis use disorder identified subgroups with differing patterns of substance involvement and clinical burden. These findings support multidimensional surveillance approaches and suggest that screening and intervention strategies may benefit from considering both use behaviors and dependence severity when identifying young adults at greatest risk.

E-cigarette use remains prevalent in the United States, yet limited research has explored e-cigarette cessation behaviors, primarily focusing on only the proportion of individuals interested in e-cigarette cessation. Understanding the sequential pathway from e-cigarette quit intention to quit attempt and abstinence may inform the development of targeted e-cigarette cessation interventions. This study used Waves 4-6 (2016-2021) restricted data from the adult questionnaire of the Population Assessment of Tobacco and Health Study (unweighted N = 1,884; weighted N = 13,406,444). We included participants who were current e-cigarette users at Wave 4. Weighted generalized structural equation modeling was employed to investigate the sequential associations between quit intention (Wave 4), any quit attempt (Wave 5), and abstinence (Wave 6), controlling for sociodemographic, psychological, and behavioral factors. Participants who with greater quit intention at Wave 4 were more likely to report any quit attempt at Wave 5 (OR = 1.23, p < 0.001). Participants who made any quit attempt at Wave 5 were more likely to achieve abstinence at Wave 6 (OR = 1.69, p < 0.05). However, the direct association between Wave 4 quit intention and successful abstinence at Wave 6 was not significant. This study is among the first to use nationally representative data to examine the sequential pathway of e-cigarette cessation behaviors among U.S. adults. Our results support the importance of designing and implementing tailored efforts that target different stages of e-cigarette cessation, including initiating and enhancing quit intention, promoting and supporting quit attempt, and facilitating the maintenance of abstinence.

Background: Positive expectancies of cannabis use effects, which are the beliefs about the anticipated positive effects of cannabis, are robust cognitive precursors of adolescent cannabis initiation and escalation. However, little is known about how sociodemographic, familial, and psychopathological factors predict positive expectancies of cannabis use effects or how these expectancies evolve across early adolescence. Objective: This study aimed to identify distinct developmental trajectories of positive expectancies of cannabis use effects among early adolescents, as well as the longitudinal effects of familial factors on positive expectancies of cannabis use effects over time. Methods: This study used latent class growth analysis with 3 waves of longitudinal data from the Adolescent Brain Cognitive Development Study (ABCD Study) to identify distinct trajectories of positive expectancies of cannabis use effects among a large, demographically diverse cohort of early adolescents (aged 10‐13 years). Multinomial logistic regression was used to examine whether baseline sociodemographic and policy-level factors were associated with class membership. Time-varying effects of familial factors (ie, parental monitoring, family cannabis use rules, and family conflict) and adolescents’ psychopathology were examined within and across trajectory classes using class-specific and common effects models. Results: Four distinct trajectories of positive expectancies of cannabis use effects emerged with different profiles: moderate-increasing (3118/7409, 42.1%), high-increasing (2111/7409, 28.5%), low-increasing (1496/7409, 20.2%), and high-decreasing (684/7409, 9.2%) trajectories. Parental monitoring and strict family cannabis use rules consistently predicted lower positive expectancies of cannabis use effects, particularly in the moderate- and high-increasing groups, while family conflict emerged as a robust risk factor. Psychopathological symptoms became increasingly predictive of positive expectancies of cannabis use effects at later ages, suggesting a developmental shift in vulnerability. Conclusions: The development of positive expectancies of cannabis use effects in early adolescence is heterogeneous and shaped by the interplay among sociodemographic, familial, and psychopathological factors. These findings highlight the critical window for early, family-based prevention and underscore the importance of tailoring intervention strategies to specific developmental and risk profiles.

Purpose: This study examined nativity differences in social and structural correlates of single and polytobacco product use among United States (U.S.) Black young adults (YA). Design: Online cross-sectional study. Setting: United States. Sample: U.S.-born and foreign-born Black YA ages 18-25 years (N = 484) living in the U.S. Measures: Self-reported past 30-day tobacco product use, safety concerns, and food and housing insecurity measured with the Accountable Health Communities Health-Related Social Needs Screening Tool; experience of racist events measured with the schedule of racist events scale. Analysis: Stratified adjusted multinomial logistic regression analyses were conducted. Separate models were constructed for overall sample, U.S.-born YA, and foreign-born YA. All models adjusted for demographic characteristics. Models for foreign-born YA adjusted for length of stay in the U.S. Results: Overall, 18.8% (CI = 15.6-22.5) and 17.4% (CI = 14.2-21.0) of participants reported single tobacco use and polytobacco use respectively. Among foreign-born participants, exposure to racist events (aOR = 1.06, 95%CI = 1.02-1.11) and housing insecurity (aOR = 1.95, 95%CI = 1.05-3.63) were associated with higher odds of polytobacco use. Among U.S.-born participants, exposure to racist events (aOR = 1.02, 95%CI = 1.001-1.05) and safety concerns (aOR = 3.19, 95%CI = 1.51-6.73) were associated with higher odds of polytobacco use. Conclusion: Experience of racist events was associated with polytobacco use among both U.S.-born and foreign-born Black YA. However, different structural determinants were associated with polytobacco use among both groups. Results suggest need for tailored tobacco prevention efforts among Black young adults in the U.S.

As the immigrant population in the United States increases and diversifies, the necessity of examining adverse childhood experiences (ACEs) by racial and ethnic group within the immigrant population has become apparent. This study examines patterns and structural correlates of ACEs among children in Hispanic, Non-Hispanic (NH) Black, and NH White immigrant households. The National Survey of Children’s Health (2016–2023) was utilized to obtain a nationally representative sample of children (ages 0–17) for a cross-sectional study ( N = 32,094). Descriptive statistics and multinomial logistic regression models were used to examine the correlates of low ACEs (1 ACE) and high ACEs (≥ 2 ACEs). NH Black immigrant households had the highest percentage of children experiencing high (12.7%) and low ACEs (28.2%). Each incremental increase in income was associated with reduced odds of high ACEs exposure among NH Black immigrant children, but NH White immigrant children only benefited from increased income if they were in the highest income bracket (< 400% of the poverty line). English as the primary household language was associated with increased odds of high ACEs exposure among all immigrant groups. This study documents patterns and structural correlates of ACEs among children in Hispanic, NH Black, and NH White immigrant households. ACEs prevalence patterns mirror those in the general population, with children in NH Black immigrant households at highest risk. The impact of sociodemographic and structural factors varied across immigrant racial and ethnic groups, pointing to the complex interplay between socio-structural factors and immigrant group-specific stressors.

Adverse experiences during childhood (ACEs) and other adversities, such as experiences of discrimination are important risk factors for substance use, particularly among Black individuals in the United States (U.S.). Given the ethnic diversity of Black people in the U.S., it is important to examine how nativity influences the impact of these stressors on substance use risk. Participants were 484 Black young adults (YA) recruited through opt-in panels and online platforms. Nativity differences in the association between ACEs, everyday discrimination, and count of tobacco/nicotine and cannabis products used were examined with descriptive statistics, zero-inflated negative binomial (ZINB), and logistic regression models. Participants' average age was 21.96 years; 53.1% females and 37.6% foreign-born. There were nativity differences (p < 0.05) in education, ACEs, everyday discrimination and lifetime count of tobacco/nicotine and cannabis product types used. Each additional ACE and experience of everyday discrimination was associated with higher lifetime tobacco/nicotine product count by 5% (IRR = 1.05, 95% CI 1.01-1.09) and 2% (IRR = 1.02, 95% CI 1.01-1.04), respectively. ACEs were associated with lower odds of abstaining from tobacco/nicotine and cannabis products in the lifetime (aOR = 0.87, 95% CI 0.76-0.99 and aOR = 0.83 95% CI 0.73-0.95, respectively) and higher odds of co-occurring product exposure (aOR = 1.17, 95% CI 1.05-1.31). Foreign-born YA had 40% lower cannabis product count (IRR = 0.60, 95% CI 0.41-0.88) relative to U.S.-born YA. Findings emphasize the role of early life (ACEs) and societal stressors (everyday discrimination) on tobacco/nicotine and cannabis product count (i.e., exposure) among U.S.- and foreign-born Black YA.

Introduction: Tobacco use remains a major public health concern, especially during adolescence when most tobacco habits begin. Tobacco use among youth is commonly assessed through self-reports, but the validity is questioned. Biomarkers, including cotinine and total nicotine equivalents (TNE-2), offer objective indicators of tobacco exposure. However, optimal cut-points for cotinine and TNE-2 to differentiate users and non-users among youth are lacking. Aims and Methods: This study utilized data from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health Study, including 1,396 youth aged 13–17 years. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-points for cotinine and TNE-2. ROC curves were employed to determine optimal cut-points for differentiating past-7-day (P7D) and past-30-day (P30D) tobacco users from non-users, then stratified by sex. Sensitivity and specificity of the cut-points were assessed. Results: The optimal cotinine cut-point for distinguishing P7D any tobacco use was 7.18 ng/mL. Individuals with levels ≥7.18 ng/mL were classified as tobacco users, while those below this threshold were not. Males had a higher cut-point (11.85 ng/mL) compared to females (7.18 ng/mL). Similar patterns were observed for P30D any tobacco use. Sensitivity of the cut-point ranged from 69% to 86%; specificity ranged from 75% to 92%. Conclusions: This study identified optimal cotinine and TNE-2 cut-points for differentiating P7D and P30D tobacco use from non-use among youth, providing a valuable tool for objective assessment and validation of tobacco use status. Variations in cut-points by sex highlight the importance of sex differences when evaluating tobacco use status for the youth population. Implications: This study addresses challenges associated with assessing and validating self-report tobacco use among youth by identifying a potentially better way of dealing with the limitations of self-report measures for accurately capturing tobacco use behaviors, particularly among adolescents. Use of biomarkers such as cotinine and TNE-2 provides a valuable alternative approach for determining tobacco use status among youth. Incorporation of biomarker data into tobacco control efforts can improve the accuracy of tobacco use assessment, enhance understanding of youth tobacco behaviors, and ultimately contribute to reduction of tobacco use and associated health risks among this vulnerable population.

Introduction: Polysubstance use—use of more than one substance—is prevalent and an emergent public health issue. Yet not much is known about factors associated with same-day polysubstance use among adolescents. This study examined correlates of same-day tobacco and cannabis use/co-use among adolescents who use tobacco/cannabis. Methods: Cross-sectional data were from 10th and 11th grade students (n = 536) who reported tobacco/cannabis use. Regression models were used to examine intrapersonal, psychological (anxiety, depression), societal (societal concern, discrimination), and environmental (public and home secondhand smoke/vape exposure) correlates of past 30-day usage frequency (no, infrequent, and frequent use) of same-day: poly-product use (poly-tobacco/nicotine [use of different types of nicotine/tobacco]; poly-cannabis [use of different types of or marijuana/tetrahydrocannabinol (THC)]); poly-drug use [tobacco/nicotine and marijuana/THC], and nicotine and THC vape mixing. Results: Participants were predominantly Hispanic (66.23%) and male (62.50%). Among participants, 8.58%, reported frequent same-day poly-tobacco use, 13.81% frequent same-day poly-cannabis use, 13.25% frequent same-day poly-drug use, and 3.36% vape mixing. Past 30-day alcohol use was associated with higher odds (1.88–8.31, p<.05) of infrequent and frequent same day use of all study outcomes except vape mixing. Secondhand smoke/vapor exposure was consistently associated with higher odds (1.13–1.26, p < .05) of infrequent/frequent same day use. Discrimination increased the odds of some same-day polysubstance use while societal concerns had inconsistent effects across study outcomes. Conclusion: A significant proportion of adolescents who use tobacco/cannabis products might engage in high-risk use patterns. Alcohol use, societal, and environmental factors significantly increase the likelihood of same-day poly-use of tobacco and cannabis products. Implications: Frequent same-day poly-product/drug use is common among adolescents who use tobacco and/or cannabis. Alcohol use, societal concerns, and environmental exposure to secondhand smoke/vape are significant contributors to same-day poly-product/drug use and nicotine and marijuana/THC vape mixing among these adolescents. Findings suggest that while infrequent same-day poly-product/drug use may be more opportunistic and situation-dependent, often occurring in contexts where alcohol is present, frequent use may be more influenced by social contexts and environmental cues. Understanding these complex relationships between substances and high-risk use patterns is crucial for developing effective prevention strategies and treatment approaches for poly-drug use disorders.